Is CRP-guided antibiotic treatment a safe way to reduce antibiotic use in severe hospitalised patients with exacerbations of COPD?

We thank M. Miravitlles and colleagues for their interest in our work [1]. They express concern about our failure rate: 24% at 10 days, and 45% at day 30; they feel that 31% of patients of the C-reactive protein (CRP) group and 46% of patients of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy group treated with antibiotics for acute COPD exacerbation is low in this high-risk population of hospitalised patients. Although treatment failure is high in our study, it reflects the severity of our population. Indeed, the proportion of patients on antimicrobials is lower than the outpatient study population in a recently published trial from the UK [2]; however, our COPD population is more severe and consists of hospitalised patients. Their concern is safety: have we caused harm in our patients by withholding antimicrobial treatment? First, in our study population, there was no significant difference in failure rates at days 10 and 30 between the CRP and GOLD group, which strongly argues against their point that antimicrobial treatment might have prevented harmful events (table 1). Neither failure during admission, nor relapse was significantly different between both study arms. Indeed, relapses among patients with acute exacerbation of COPD admitted to hospital are common [3], especially among individuals with a low forced expiratory volume in 1 s, but antimicrobial treatment may not necessarily prevent this, in particular among those that had low in...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Original Articles: Correspondence Source Type: research