Crp guided antibiotic therapy in copd exacerbation

Chronic obstructive airway disease (COPD) is a progressive disease, that is characterized by exacerbations described by an increase in dyspnea, a decrease in daily activity, an increase in the amount of sputum, or a change in the color of sputum, cough, fever, and change in mental status. Antibiotics are commonly used in COPD exacerbations. To decrease the cost and to stop the increase in antibiotic resistance, new strategies should be found. C-reactive protein (CRP), is a classical acute phase reactant and it increases dramatically during inflammations. In the studies about CRP levels in lower airway disease, it was seen that CRP is significantly higher in bacterial infections than viral ones. It is recommended to avoid using antibiotics when CRP is <1 mg/dL. In our study that is done in order to avoid unnecessary antibiotic use in COP exacerbations, we used CRP cut-off level as 1 mg/dL during the study. In our study, CRP-guided treatment results (clinical success, early and late relapse) were as good as the standard group. At the end of the 3 months following, we used significantly higher antibiotics in the CRP group. This result may be due to more exacerbation occurring in the CRP group. The reason why more exacerbation occurred in the CRP group, is maybe ongoing cigarette smoking that is statistically higher in the CRP group. We suppose that at the different CRP cut-off values and in the study design that active cigarette smoking is controllable, results will be better in favor of CRP.