title: C-reactive protein velocity following antibiotics in patients with chronic obstructive pulmonary disease exacerbation and community acquired pneumonia.
abstract: BACKGROUND
  Distinguishing community acquired pneumonia (CAP) from chronic obstructive pulmonary disease (COPD) exacerbation is a challenging task, since fever, productive cough, dyspnea, and leukocytosis are all common features of both conditions. Moreover, chest X-ray might not be sensitive enough. It is therefore quite common for physicians to prescribe unnecessary antibiotics for COPD exacerbation, leading to resistant bacteria and other related adverse affects.
  
  
  OBJECTIVE
  To study whether CRP levels upon admission and the delta in CRP levels following initiation of antibacterial treatment, could provide an efficient tool for distinguishing CAP from COPD exacerbation.
  
  
  METHODS
  The study group included 36 COPD exacerbation and 49 CAP patients, admitted to a single Internal Medicine department during the years 2004-2006. All patients were treated with cephalosporins and macrolides upon admission.
  
  
  RESULTS
  CRP levels upon admission were significantly higher among CAP patients than among COPD exacerbation patients (111.5+/-104.4 vs. 34.9+/-28.6 mg/l, p<0.0001). CRP levels on the second day of hospitalization, following antibiotic administration to all patients, made a sharp incline in 36.7% of CAP patients compared to only 5.9% of COPD exacerbation patients (p=0.005), and remained unchanged in 61.8% of COPD patients compared to 16.3% of CAP patients (p=0.0006).
  
  
  CONCLUSIONS
  CRP levels upon admission and the delta in CRP levels following initiation of antibacterial treatment could provide an efficient tool for distinguishing CAP from COPD exacerbation.
authors.affiliation: Department of Internal Medicine D, Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv, Israel. justo1@bezeqint.net
authors.forename: Dan
authors.initials: D
authors.lastname: Justo
authors.forename: Saar
authors.initials: S
authors.lastname: Lachmi
authors.forename: Nili
authors.initials: N
authors.lastname: Saar
authors.forename: Erel
authors.initials: E
authors.lastname: Joffe
authors.forename: Lihi
authors.initials: L
authors.lastname: Atzmony
authors.forename: Noa
authors.initials: N
authors.lastname: Mashav
authors.forename: Oren
authors.initials: O
authors.lastname: Henis
authors.forename: Ben
authors.initials: B
authors.lastname: Sade
authors.forename: Tamar
authors.initials: T
authors.lastname: Chundadze
authors.forename: Arie
authors.initials: A
authors.lastname: Steinvil
authors.forename: Yael
authors.initials: Y
authors.lastname: Paran
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000378:metabolism*; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy; D003937:Diagnosis, Differential; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood* / Q000150:complications* / Q000188:drug therapy; D012120:Respiration Disorders / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein