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dc.contributor.authorButler, Christopher C
dc.contributor.authorGillespie, David
dc.contributor.authorWhite, Patrick
dc.contributor.authorBates, Janine
dc.contributor.authorlowe, rachel
dc.contributor.authorThomas-Jones, Emma
dc.contributor.authorWootton, Mandy
dc.contributor.authorHood, Kerenza
dc.contributor.authorPhillips, Rhiannon
dc.contributor.authorMelbye, Hasse
dc.contributor.authorLlor, Carl
dc.contributor.authorCals, Jochen W L
dc.contributor.authorNaik, Gurudutt
dc.contributor.authorKirby, Nigel
dc.contributor.authorGal, Micaela
dc.contributor.authorRiga, Evgenia
dc.contributor.authorFrancis, Nick A
dc.date.accessioned2020-03-30T06:48:00Z
dc.date.available2020-03-30T06:48:00Z
dc.date.issued2019-07-11
dc.description.abstract<i>BACKGROUND</i> - Point-of-care testing of C-reactive protein (CRP) may be a way to reduce unnecessary use of antibiotics without harming patients who have acute exacerbations of chronic obstructive pulmonary disease (COPD).<p><p> <i>METHODS</i> - We performed a multicenter, open-label, randomized, controlled trial involving patients with a diagnosis of COPD in their primary care clinical record who consulted a clinician at 1 of 86 general medical practices in England and Wales for an acute exacerbation of COPD. The patients were assigned to receive usual care guided by CRP point-of-care testing (CRP-guided group) or usual care alone (usual-care group). The primary outcomes were patient-reported use of antibiotics for acute exacerbations of COPD within 4 weeks after randomization (to show superiority) and COPD-related health status at 2 weeks after randomization, as measured by the Clinical COPD Questionnaire, a 10-item scale with scores ranging from 0 (very good COPD health status) to 6 (extremely poor COPD health status) (to show noninferiority).<p><p> <i>RESULTS</i> - A total of 653 patients underwent randomization. Fewer patients in the CRP-guided group reported antibiotic use than in the usual-care group (57.0% vs. 77.4%; adjusted odds ratio, 0.31; 95% confidence interval [CI], 0.20 to 0.47). The adjusted mean difference in the total score on the Clinical COPD Questionnaire at 2 weeks was −0.19 points (two-sided 90% CI, −0.33 to −0.05) in favor of the CRP-guided group. The antibiotic prescribing decisions made by clinicians at the initial consultation were ascertained for all but 1 patient, and antibiotic prescriptions issued over the first 4 weeks of follow-up were ascertained for 96.9% of the patients. A lower percentage of patients in the CRP-guided group than in the usual-care group received an antibiotic prescription at the initial consultation (47.7% vs. 69.7%, for a difference of 22.0 percentage points; adjusted odds ratio, 0.31; 95% CI, 0.21 to 0.45) and during the first 4 weeks of follow-up (59.1% vs. 79.7%, for a difference of 20.6 percentage points; adjusted odds ratio, 0.30; 95% CI, 0.20 to 0.46). Two patients in the usual-care group died within 4 weeks after randomization from causes considered by the investigators to be unrelated to trial participation.<p><p> <i>CONCLUSIONS</i> - CRP-guided prescribing of antibiotics for exacerbations of COPD in primary care clinics resulted in a lower percentage of patients who reported antibiotic use and who received antibiotic prescriptions from clinicians, with no evidence of harm.en_US
dc.identifier.citationButler, Gillespie D, White P, Bates J, lowe, Thomas-Jones E, Wootton M, Hood K, Phillips R, Melbye H, Llor C, Cals JWL, Naik G, Kirby N, Gal M, Riga E, Francis NA. C-reactive protein testing to guide antibiotic prescribing for COPD exacerbations. New England Journal of Medicine. 2019;381(2):111-120en_US
dc.identifier.cristinIDFRIDAID 1778036
dc.identifier.doihttps://doi.org/10.1056/NEJMoa1803185
dc.identifier.issn0028-4793
dc.identifier.issn1533-4406
dc.identifier.urihttps://hdl.handle.net/10037/17901
dc.language.isoengen_US
dc.publisherMassachusetts Medical Societyen_US
dc.relation.journalNew England Journal of Medicine
dc.rights.accessRightsopenAccessen_US
dc.rights.holderCopyright © 2019 Massachusetts Medical Society.en_US
dc.subjectVDP::Medical disciplines: 700en_US
dc.subjectVDP::Medisinske Fag: 700en_US
dc.titleC-reactive protein testing to guide antibiotic prescribing for COPD exacerbationsen_US
dc.type.versionpublishedVersionen_US
dc.typeJournal articleen_US
dc.typeTidsskriftartikkelen_US
dc.typePeer revieweden_US


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