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Point-of-Care Protein C-Protein (CRP) Testing in Primary Care Clinics Can Reduce the Unnecessary Use of Antibiotics in Patients with Exacerbation of Chronic Obstructive Pulmonary Disease (COPD) ), show the data.
"The prescription of CRP-guided antibiotics in the treatment of COPD exacerbations in primary health care clinics has resulted in a decrease in the percentage of patients reporting antibiotic use and having received a prescription antibiotics from clinicians, "writes Christopher C. Butler, FMedSci, Nuffield. Department of Health Sciences in Primary Care, University of Oxford, UK, and colleagues.
The results were published online on July 10 in New England Journal of Medicine.
CRP is an acute phase protein that can be measured accurately at the point of treatment in just a few minutes. It is a biomarker for badessing acute exacerbations of COPD, explain the authors.
They write: "Government organizations, industry and clinical guidelines encourage on-site screening tests for acute infections, in order to better target prescription antibiotics, limit antimicrobial resistance, and reduce the risk of infection." 39, improve results for patients.
"However, most point-of-care badessments for acute infections focused only on badytic performance, with only a few trials evaluating the effectiveness of such tests to improve outcomes in patients for whom the tests are performed. intended for use. "
The researchers conducted a multicentre, open, randomized, and controlled study of patients who visited one of the 86 general practice practices in England and Wales for an acute exacerbation of COPD, defined as the presence of patients with COPD. at least one of the criteria of Anthonisen (increased dyspnea). volume of sputum and purulence of sputum). Patients in the CRP-guided group (325 patients) received the usual care that was guided by CRP point-of-care testing; patients in the usual care group (324 patients) received usual care only.
To evaluate the use of antibiotics and health outcomes related to COPD, the researchers used two main evaluation criteria: the use of antibiotics reported by the patient for acute exacerbations of COPD within 4 weeks of randomization and COPD-related health status 2 weeks after randomization, badessed using the clinical COPD method. Survey.
At 4 weeks, fewer patients in the CRP group had used antibiotics than in the usual care group (57.0% vs. 77.4% adjusted odds ratio). [aOR]0.31; 95% confidence interval [CI]0.20 – 0.47).
"Patients who had two or three criteria Anthonisen were less likely to receive a prescription for antibiotics if they belonged to the group led by CRP, this finding shows that some patients whose sputum volume or purulence were higher rates also had low CRP levels and did not use antibiotics. "Allan S. Brett, MD, and Majdi N. Al Hasan, MB, of the University's Faculty of Medicine from South Carolina, to Columbia, write in an editorial.
In the clinical COPD questionnaire, the adjusted mean difference in total score at 2 weeks was -0.19 points (90% CI, -0.33 to -0.05), which was below the limit. prespecified for non inferiority.
The authors found no significant difference from other COPD-related badessment criteria, such as primary care or specialist consultation, diagnosis of pneumonia, or use of medical care. health for 6 months.
Two patients in the usual care group died within 4 weeks of participating in the study for causes deemed unrelated to the study.
"In our opinion, the results of this study are sufficiently convincing to support the CRP test as a complementary measure to guide the use of antibiotics in patients with acute exacerbation of COPD. in the US would include the CRP test at the point of treatment This is another matter, given the regulatory requirements for office lab tests and uncertainty about reimbursement, "explain Brett and Al-Hasan .
Editorials say that relatively few patients report to primary care practices to treat acute exacerbations of COPD; However, the CRP test at the place of treatment has reduced the prescription of antibiotics in patients with more common clinical manifestations, such as presumed lower respiratory tract infections, and could therefore be used more widely .
"One last point deserves to be underlined", emphasize editorialists. "[This] One study suggests only one way to reduce the prescription of antibiotics without compromising clinical outcomes. It does not indicate which patients (if any) actually benefit from antibiotic treatment nor which antibiotics are most appropriate for exacerbations of COPD. Additional clinical trials will be needed to address these uncertainties. "
Alere (now Abbott) provided devices and training badociated with the participating general practices at no cost to the study. Butler has received personal fees from Roche Molecular Systems and grants from Roche Molecular Diagnostics. A coauthor received grants from Abbott Diagnostics; another co-author received a grant from Merck Sharp Dohme. The editorialists have not revealed any relevant financial relationship.
N Engl J Med. Posted online July 10, 2019. Abstract, Editorial
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