Is it possible to identify exacerbations of mild to moderate COPD that do not require antibiotic treatment?
Chest. 2013 Jun 27;
Authors: Miravitlles M, Moragas A, Hernández S, Bayona C, Llor C
ABSTRACT BACKGROUND: Anthonisen's criteria are widely used to guide the need for antibiotics in exacerbations of chronic obstructive pulmonary disease (COPD). We evaluated the best predictors of outcomes in exacerbations of mild to moderate COPD not treated with antibiotics.
METHODS: We used data from 152 patients of the placebo arm of a randomised trial of amoxicillin/clavulanate for exacerbations of mild to moderate COPD. Clinical response in relation to Anthonisen's criteria and point-of-test serum C-reactive protein (CRP) levels (cut off 40 mg/L) was assessed with multivariate logistic regression analysis.
RESULTS: Clinical failure without antibiotics was 19.9% compared to 9.5% with amoxicillin/clavulanate (p=0.022). The only factors significantly associated with an increased risk of failure without antibiotics were the increase in purulence of sputum (OR=6.1, 95% confidence interval: 1.5 to 25.0; p=0.005) and a CRP concentration ≥40 mg/L (OR=13.4, 95%CI: 4.6 to 38.8; p<0.001). When both factors were present, the probability of failure without antibiotics was 63.7%. The Anthonisen criteria showed an area under the curve (AUC) of 0.708 (95% CI: 0.616 - 0.801) for predicting clinical outcome. With the addition of CRP, the AUC rose significantly to 0.842 (95% CI: 0.76 - 0.924); p<0.001.
CONCLUSION: Among the Anthonisen criteria, only an increase in sputum purulence is a significant predictor of failure without antibiotics. The use of a point-of-test CRP significantly increases the predictive accuracy of failure. Both of these easy to obtain factors may help clinicians to identify exacerbated mild to moderate COPD patients that can be safely treated without antibiotics in an ambulatory setting.
CLINICAL TRIAL REGISTRATION NUMBER: clinicaltrials.gov; No.: NCT00495586.
PMID: 23807094 [PubMed - as supplied by publisher]