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- Page navigation anchor for Pneumonia, exacerbation of COPD or both? Antibiotic prescribing in the context of diagnostic uncertainty in primary carePneumonia, exacerbation of COPD or both? Antibiotic prescribing in the context of diagnostic uncertainty in primary care
We read the manuscript by Gillespie and colleagues with great interest.¹ The landmark ‘PACE’ trial demonstrated that C-reactive protein point-of-care testing (CRP-POCT) in primary care can reduce patient-reported antibiotic consumption by approximately 20%, without evidence of harm, in acute exacerbations of COPD (AECOPD).² The exploratory analysis by Gillespie et al identified clinician-reported chest auscultation findings as being associated with a higher odds of antibiotic prescription.¹ As the authors note, this may reflect a perception from clinicians that chest auscultation findings, such as crackles, are associated with a higher likelihood of pneumonia; this is an important consideration and warrants further discussion.
The pathophysiology of COPD exacerbations is complex; evidence suggests that viruses and bacteria play key roles and that viral infection may precede secondary bacterial infection in certain patients.³ ⁴ Moreover, viral-bacterial co-infection can occur and has been observed in ~25% of hospitalised patients with severe infective AECOPD.⁵ A key challenge in primary care is diagnosing and recognising the importance of concomitant pneumonia.⁶ Crucially, evidence suggests that concomitant pneumonia is associated with worse outcomes in hospitalised patients with AECOPD.⁷ In the absence of radiological investigation, it may be difficult to confidently distinguish pneumonic- from nonpneumonic-AECOPD in p...
Competing Interests: None declared.