Association between point-of-care CRP testing and antibiotic prescribing in respiratory tract infections: a systematic review and meta-analysis of primary care studies

Abstract

Background

FebriDx Point-of-Care Testing to Guide Antibiotic Therapy for AcuteRespiratory Tract Infection in UK Primary Care: A Retrospective OutcomeAnalysis

“…A normal CRP in a patient with symptoms of respiratory infection usually indicates a self-limiting infection that does not require referral to hospital or antibiotic treatment, although it may also be observed early in the presentation of an illness [29]. A systematic review and meta-analysis of 13 studies in primary care demonstrated CRP testing led to significantly reduced antibiotic prescribing at the index consultation [19]. Patient recovery without antibiotics at the same speed and with comparable rates of complications (hospitalisation, mortality, and number of re-infections), suggest that the infection was of non-bacterial origin or so mild that the immune defense could clear the infection unassisted [30].…”

“…A meta-analysis that looked at 13 studies of upper respiratory tract infection (URI) and lower respiratory tract infection (LRTI) on the association between point-of-care (POC) C-reactive protein (CRP) testing and antibiotic prescribing for ARTIs in general practice found that CRP testing significantly decreased antibiotic prescribing at the initial consultation [19]. Any reduction in antibiotic consumption will have a relatively higher impact when done in a primary care setting [20,21].…”

Role of antibiotic stewardship in extending the age of modern medicine

“…Both CRP [27,28] and PCT [29,30] have demonstrated utility in differentiating bacterial from viral acute respiratory infection (ARI) in developed countries, and for PCT its use has been estimated to confer substantial economic gains (USD1.6 billion (ZAR18.8 billion) savings if used across the US health sector) in HICs. [31] In a high tuberculosis-prevalence country such as SA, the utility of CRP and PCT is less clear for ARI, as both are increased in tuberculosis.…”

Diagnosis of bacterial infection

“…A number of useful tests are now available, including CRP, which have been shown in clinical trials to reduce antibiotic prescription for respiratory tract infections. [7] Procalcitonin (PCT) is 10 times more expensive than CRP or WCC tests, but more specific for bacterial infection. There is good evidence that antibiotics can safely be withheld, based on low PCT in acute meningitis, acute exacerbations of chronic obstructive pulmonary disease and upper respiratory tract infections.…”