Replying to Junwei Föhr 16/03/2024 - 10:29
Hello.
I hope you are well. I do indeed use CRP as a way of monitoring aspiration pneumonia cases. It can be a helpful tool to help determine when to stop antibiotics as you mention. This paper looked at CRP use in dogs with aspiration pneumonia and whether it is a reliable indicator of when to stop antibiotics. They found that in dogs where CRP normalised and clinical signs resolved that antibiotics were discontinued in as little as 1 week! This is much shorter than the traditional length of time, or 2 weeks past resolution on radiographs/ thoracic ultrasound (remembering imaging improvement often lags behind clinical).
CRP is gaining more and more attention as a marker for when to stop antimicrobial treatment, and although this cohort was small I think it shows some useful findings. Here is the abstract, and the paper is open access through JVIM.
https://pubmed.ncbi.nlm.nih.gov/35348224/
Abstract
Background
Evidence regarding optimal treatment duration in dogs with aspiration pneumonia (AP) and the role of thoracic radiographs (TXR) and lung ultrasonography (LUS) in the long-term follow-up of affected dogs is lacking. C-reactive protein (CRP) is a reliable acute phase protein to monitor bacterial pneumonia in dogs.
Hypothesis
Investigate the safety of antimicrobial discontinuation based on clinical improvement and serum CRP normalization, as well as the usefulness of TXR and LUS for follow-up.
Animals
Dogs diagnosed with AP and treated with antimicrobials.
Methods
Prospective observational study. Antimicrobials were discontinued based on clinical improvement and serum CRP normalization after 1, 3, or 5 weeks. At each consultation, a quality-of-life questionnaire, physical examination, serum CRP, TXR, and LUS were assessed. Short- (2 weeks) and long-term (>1 month) follow-ups after treatment discontinuation were performed to monitor for possible relapses.
Results
Seventeen dogs were included. Antimicrobials were discontinued after 1 week in 12 dogs (70.6%) and 3 weeks in the remaining 5 dogs (29.4%). Short-term relapse was not observed in any dog and long-term relapse was diagnosed in 3 dogs. Thoracic radiographs and LUS were useful for diagnosis, but did not add additional information during follow-up, because image normalization lagged behind clinical improvement and serum CRP normalization.
Conclusion and Clinical Importance
Dogs with AP can be safely and effectively treated using a short-term antimicrobial regimen discontinued after clinical improvement and serum CRP normalization. Imaging might still be useful for complicated cases with a less favorable response to treatment.
Scott 🙂
