CRP test could safely reduce antibiotic use by COPD patients

Point-of-care testing of C-reactive protein (CRP) in primary care may help reduce unnecessary prescribing of antibiotics for people with COPD, according to new research published in the New England Journal of Medicine (NEJM).

This study was earlier presented as an abstract by Nick Francis, Professor of Primary Care Research Cardiff University, at last year’s PCRS Respiratory Conference where it won the Best Original Research Abstract prize. 

Known as the PACE study, the multicentre trial, conducted at primary care clinics in England and Wales, involved 653 patients in 86 UK general practices with an acute exacerbation of COPD. Patients were randomised to receive usual care guided by CRP point-of-care testing or usual care only.

When GPs used a CRP rapid finger prick test, there was a 20% reduction in antibiotic prescribing by clinicians as well as a reduction in antibiotic use by patients with COPD exacerbations.

Importantly, this reduction in antibiotic use did not have a negative effect on patients’ recovery over the first two weeks after their consultation at their GP surgery, or on their well-being or use of health care services over the following six months. 

An editorial accompanying the paper in the NEJM comments: “In our view, the findings from this study are compelling enough to support CRP testing as an adjunctive measure to guide antibiotic use in patients with acute exacerbations of COPD.”

The trial was funded by the National Institute for Health Research (NIHR) Health Technology Assessment Programme.  In an NIHR blog, Nick Francis and Chris Butler (Professor of Primary Care in the Nuffield Department of Primary Care Health Sciences and NIHR Senior Investigator) say that the next steps of their research include publishing the health economic findings from the study and identifying steps to overcome implementation barriers - such as ensuring mechanisms for funding the test are in place and clinicians feel confident in using it.

“Our process evaluation found that money and time considerations will be absolutely critical to the implementation of this evidence,” they comment.

Dr Helen Ashdown, PCRS Research Lead, says: “This is a good example of something where the evidence is there and the implementation into practice just needs to follow. CRP-guided treatment is already common outside of the UK for acute respiratory infections, particularly in Scandinavia.

“It was fantastic for PCRS conference delegates last year to be some of the first to hear about real practice-changing findings, which should make their way into guidelines in years to come, and will play an important part in helping to reduce the global problem of antimicrobial resistance. Further work done as part of the PACE study will be presented in the scientific research stream at this year’s conference.”

The PCRS Respiratory Conference 2019 will be showcasing another selection of cutting edge respiratory scientific research in primary care.  It is the only UK event in the academic calendar with a stream entirely dedicated to primary care respiratory research.