PACE

Background

COPD is common and acute exacerbations account for considerable suffering and resource use. Antibiotics are usually prescribed for acute exacerbations, despite evidence that they do not benefit patients who have a low C-reactive protein (CRP).

Pollutants, changes in the weather and viral as well as bacterial infection, can trigger COPD exacerbations so how do you determine when to use antibiotics? Overuse of antibiotics can have down sides for patients (side effects, increased risk of subsequent resistant infection) as well as for society (increasing antimicrobial resistance, costs). Equally, underuse might also bring harm to some individuals with COPD. Current antibiotic prescribing recommendations for COPD exacerbations are generally based on symptoms alone. However, symptoms on their own do not have sufficient diagnostic accuracy to predict which patients are likely to benefit from antibiotic treatment and which patients can safely be managed without antibiotics.

C-reactive protein (CRP) is an acute phase protein and serum levels increase rapidly in severe bacterial infections. A recent trial found evidence that those with low CRP levels did not benefit from antibiotics, but using CRP to guide antibiotic treatment decisions has not yet been evaluated in a trial.