Nav: Home

Finger-prick blood test could safely reduce antibiotic use in patients with COPD

July 11, 2019

A simple finger-prick blood test could help prevent unnecessary prescribing of antibiotics for people with the lung condition chronic obstructive pulmonary disease (COPD), according to a new study by researchers from Cardiff University, University of Oxford and King's College London.

With funding from the National Institute for Health Research, the team demonstrated that using a CRP finger-prick blood test resulted in 20% fewer people using antibiotics for COPD flare-ups.

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.

Safely reducing the use of antibiotics in this way may help in the battle against antibiotic resistance.

More than a million people in the UK have COPD, which is a lung condition associated with smoking and other environmental pollutants. People living with the condition often experience exacerbations, or flare-ups, and when this happens, three out of four are prescribed antibiotics. However, two -thirds of these flare-ups are not caused by bacterial infections and antibiotics often do not benefit patients.

Professor Nick Francis, from Cardiff University's School of Medicine, said: "Governments, commissioners, clinicians, and patients living with COPD around the world are urgently seeking tools to help them know when it is safe to withhold antibiotics and focus on treating flare-ups with other treatments.

"This is a patient population that are often considered to be at high risk from not receiving antibiotics, but we were able to achieve a reduction in antibiotic use that is about twice the magnitude of that achieved by most other antimicrobial stewardship interventions, and demonstrate that this approach was safe."

The finger-prick test measures the amount of C- reactive protein (CRP) - a marker of inflammation that rises rapidly in the blood in response to serious infections. People with a COPD flare-up who have a low CRP level in the blood appear to receive little benefit from antibiotic treatment.

Professor Chris Butler, from the University of Oxford, said: "This rigorous clinical trial speaks directly to the pressing issues of; preserving the usefulness of our existing antibiotics; the potential of stratified, personalised care; the importance of contextually-appropriate evidence about point of care testing in reducing unnecessary antibiotic use, and; enhancing the quality of care for people with the common condition of chronic obstructive pulmonary disease.

"Most antibiotics are prescribed in primary medical care, and many of these prescriptions do not benefit patients: point of care testing is being vigorously promoted as a critical solution for better targeted antibiotic prescribing. However, there have been virtually no trials of point of care tests that measure impact on clinician behaviour, patient behaviour and patient outcomes. Acute exacerbations of chronic pulmonary disease account for considerable proportion of unnecessary antibiotic use, but a good solution to the problem in ambulatory care (where most of the antibiotics are prescribed) has not been identified until now. Ours is the first trial of biomarker guided management of AECOPD in ambulatory care, and has found an effect that should be practice-changing."

Jonathan Bidmead and Margaret Barnard were the patient and public representatives on the PACE study, providing a voice for patients with COPD: Jonathan Bidmead commented: "We need to highlight not only how many people are saved by antibiotics but also that many are harmed though unnecessary antibiotic use. As a COPD sufferer, I know that antibiotics are routinely used at the first sign of an exacerbation: this study has shown that doctors can use a simple finger-prick test in a consultation to better identify those instances where antibiotics will probably do no good and may even do some harm. This can help us focus on other treatments that may be more helpful for some exacerbations."

Professor Hywel Williams, Director of the NIHR's Health Technology Assessment (HTA) Programme, said: "This is a really important study which provides clear evidence that a simple biomarker blood test carried out in GP surgeries on people with chronic obstructive pulmonary disease experiencing flare-ups, has the potential to reduce unnecessary prescribing of antibiotics, without adversely affecting recovery from these flare-ups. This in turn helps tackle the wider global health hazards of antimicrobial resistance (AMR).

"The NIHR is committed to research in areas of greatest health need, such as AMR. This study is one of a number which we have funded over the last few years in this crucial area, in our sustained effort to tackle this worldwide threat."
-end-
The research 'C-reactive Protein Guided Antibiotic Prescribing for COPD Exacerbations' is published in the New England Journal of Medicine.

Notes for editors

The PACE study is the first randomised controlled trial to address the question of whether measuring CRP with a point of care test in people with acute exacerbation could lead to fewer antibiotics being used without having negative effects for patients.

653 people who were seen at their GP surgeries in England and Wales for a COPD flare-up (AECOPD) were included in the study and randomly assigned to either 1) usual care with the addition of a CRP point of care test or 2) usual care without the test. Antibiotics were taken for COPD flare-ups by 57% of people in the CRP point-of-care test group and 77% of people in the usual care group in the four weeks following their initial consultation.

Cardiff University PACE page: https://www.cardiff.ac.uk/centre-for-trials-research/research/themes/infections/pace-study

PACE Study website: http://www.pace-study.co.uk

Cardiff University

Related Antibiotics Articles:

Antibiotics promote resistance on experimental croplands
Canadian researchers have generated both novel and existing antibiotic resistance mechanisms on experimental farmland, by exposing the soil to specific antibiotics.
Why antibiotics fail
UCSB biologists correct a flaw in the way bacterial susceptibility to these drugs is tested.
Fungi have enormous potential for new antibiotics
Fungi are a potential goldmine for the production of pharmaceuticals.
Antibiotics can boost bacterial reproduction
The growth of bacteria can be stimulated by antibiotics, scientists at the University of Exeter have discovered.
Last-line antibiotics are failing
The ECDC's latest data on antimicrobial resistance and consumption shows that in 2015, antibiotic resistance continued to increase for most bacteria and antibiotics under surveillance.
Two antibiotics fight bacteria differently than thought
Two widely prescribed antibiotics -- chloramphenicol and linezolid -- may fight bacteria in a different way from what scientists and doctors thought for years, University of Illinois at Chicago researchers have found.
Preserving the power of antibiotics
News release describes efforts to address inappropriate antibiotic prescribing in emergency departments and urgent-care centers nationwide, which a JAMA study published this past May found rates as high as 50 percent for acute respiratory infections in US emergency departments.
Antibiotics could be cut by up to one-third, say dairy farmers
Nine in 10 dairy farmers participating in a new survey from the Royal Association of British Dairy Farmers (RADBF) say that the farming industry must take a proactive lead in the battle against antibiotic resistance.
Antibiotics may be inappropriate for uncomplicated diverticulitis
Antibiotics are advised in most guidelines on diverticulitis, which arises when one or more small pouches in the digestive tract become inflamed or infected.
New book on Antibiotics and Antibiotic Resistance from CSHLPress
'Antibiotics and Antibiotic Resistance' from CSHLPress examines the major classes of antibiotics, together with their modes of action and mechanisms of resistance.

Related Antibiotics Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Digital Manipulation
Technology has reshaped our lives in amazing ways. But at what cost? This hour, TED speakers reveal how what we see, read, believe — even how we vote — can be manipulated by the technology we use. Guests include journalist Carole Cadwalladr, consumer advocate Finn Myrstad, writer and marketing professor Scott Galloway, behavioral designer Nir Eyal, and computer graphics researcher Doug Roble.
Now Playing: Science for the People

#530 Why Aren't We Dead Yet?
We only notice our immune systems when they aren't working properly, or when they're under attack. How does our immune system understand what bits of us are us, and what bits are invading germs and viruses? How different are human immune systems from the immune systems of other creatures? And is the immune system so often the target of sketchy medical advice? Those questions and more, this week in our conversation with author Idan Ben-Barak about his book "Why Aren't We Dead Yet?: The Survivor’s Guide to the Immune System".