Biomarkers as point-of-care tests to guide prescription of antibiotics in people with acute respiratory infections in primary care

Smedemark, Siri Aas; Llor, Carl; Aabenhus, Rune; Fournaise, Anders Vestergaard; Jørgensen, Karsten Juhl; Olsen, Ole

doi:10.1002/14651858.cd010130.pub3

Cited by 25 publications

(27 citation statements)

References 129 publications

(11 reference statements)

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“…In line with findings from primary care practices,11 12 our results indicate that point-of-care CRP testing may have the potential to reduce antibiotic prescriptions in OEMS, which is especially important under the light of the rise of antibiotic resistance. The result of our study are also consistent with another primary care study showing that clinicians perceive that CRP-POCTs increase confidence, reduce diagnostic uncertainty and facilitate communication between patients and clinicians 34.…”

Section: Discussionsupporting

confidence: 79%

“…CRP has a diagnostic value (although limited in some cases) in differentiating between bacterial and viral infections9 as well as estimating the severity of bacterial infections 10. POCT measurement of CRP has been shown to safely reduce antibiotic prescriptions in respiratory tract infections (RTI) in primary care settings11 12 as well as in nursing homes 13. There is also evidence that CRP-POCTs can improve antibiotic prescriptions14 and shorten the length of stay in emergency medical services 15–17.…”

Section: Introductionmentioning

confidence: 99%

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Point-of-care measurement of C-reactive protein promotes de-escalation of treatment decisions and strengthens the perceived clinical confidence of physicians in out-of-hours outpatient emergency medical services

et al. 2023

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ObjectivesOut-of-hours outpatient emergency medical services (OEMS) provide healthcare for patients with non-life-threatening conditions in need for urgent care when outpatient practices are closed. We studied the use of point-of-care-testing of C-reactive protein (CRP-POCT) at OEMS.DesignCross-sectional questionnaire-based survey.SettingSingle centre OEMS practice in Hildesheim, Germany (October 2021 to March 2022).ParticipantsOEMS physicians answering a questionnaire immediately after performing CRP-POCTs (CUBE-S Analyzer, Hitado) on any patients.Primary and secondary outcomesImpact of CRP-POCTs on clinical decision-making and perceived usefulness.ResultsIn the 6-month study period, 114 valid CRP-POCTs were performed in the OEMS practice by 18 physicians and the questionnaire was answered in 112 cases (response rate: 98.2%). CRP-POCTs were used in the diagnosis of inflammatory diseases of the gastrointestinal tract (60.0%), respiratory tract infections (17.0%), urinary tract infections (9.0%) and other non-gastrointestinal/non-specified infections (11.0%). The use of a CRP-POCT resulted in a change of the physicians’ clinical decision in 83.3% of the cases. Specifically, in 13.6% and 35.1% of the cases, rapid CRP measurements led to decision changes in the (1) initiation of antimicrobial therapy and (2) other drug treatment, respectively. Notably, in 60% of all cases, the use of a CRP-POCT reportedly changed the decision on hospitalisation/non-hospitalisation of OEMS patients. In respect of antimicrobial therapy and hospitalisation, these decision changes primarily (≥73%) promoted ‘step-down’ decisions, that is, no antibiotic therapy and no hospital admission. In the great majority of CRP-POCT applications (≥95%), OEMS physicians reported that rapid CRP measurements increased the confidence in their diagnostic and therapeutic decision. In almost all cases (97%), physicians rated the CRP-POCT use as useful in the treatment situation.ConclusionQuantitative CRP-POCT promotes step-down clinical decisions and strengthens the clinical confidence of physicians in out-of-hours OEMS.

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Section: Discussionsupporting

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Point-of-care measurement of C-reactive protein promotes de-escalation of treatment decisions and strengthens the perceived clinical confidence of physicians in out-of-hours outpatient emergency medical services

et al. 2023

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“…23 A Cochrane review on the subject found that CRP POCT testing for ARTIs in general practice can reduce antibiotic use, and the intervention is unlikely to increase morbidity. 20 We aim to study if CRP POCT testing in primary care can safely reduce antibiotic use in children with ARTI in Kyrgyzstan.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

“… 19 Randomised trials of using CRP point-of-care test (POCT) to guide antibiotic prescription for respiratory tract infections have been successful in lowering unnecessary antibiotic prescriptions in high-income countries and some LMIC countries. 20 21 Trials of CRP POCT in children have been performed in Tanzania as part of an intervention package with a strict prescription limit of >80 mg/L CRP with a significant reduction in antibiotic prescriptions from 40% to 2%. 21 In South-East Asia, a CRP intervention produced a smaller but significant effect (5%) in children and adults.…”

Section: Introductionmentioning

confidence: 99%

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C reactive protein-guided prescription of antibiotics for children under 12 years with respiratory symptoms in Kyrgyzstan: protocol for a randomised controlled clinical trial with 14 days follow-up

et al. 2023

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IntroductionWhile lower respiratory tract infections are the main cause of death for children under 5 globally, only a small proportion of children with respiratory tract infections need antibiotics. Overuse of antibiotics globally is leading to increasing rates of antibiotic resistance. In Kyrgyzstan, healthcare workers regularly prescribe antibiotics when clinical uncertainty is present to err on the side of caution. Targeting antibiotic use with biomarkers of inflammation such as C reactive protein (CRP) testing at the point-of-care test (POCT) has been shown to reduce antibiotic use in general, but only few studies have been done in children and no studies exist from Central Asia. This study aims to assess whether the use of a CRP POCT can safely decrease prescription of antibiotics for children with acute respiratory symptoms in primary level healthcare centres in Kyrgyzstan.Methods and analysisMulticentre, open-label, individually randomised, controlled clinical trial with 14 days follow-up (follow-up by phone on days 3, 7 and 14) in rural lowland Chui and highland Naryn regions of Kyrgyzstan. The population are children aged 6 months to 12 years attending the primary level healthcare centres during normal business hours with acute respiratory symptoms. CRP POCT equipment will be supplied to healthcare centres, along with a short training session in CRP use, including the interpretation of results to support the clinical evaluation of the child with acute respiratory infection. The primary outcomes are the proportion of patients prescribed an antibiotic within 14 days of index consultation (superiority analysis) and days to recovery (non-inferiority analysis). Secondary outcomes are antibiotics prescribed at index consultation, reconsultations, hospital admission and vital status within 14 days. Analysis of the first primary outcome, antibiotic use, will be intention to treat using a logistic regression model. Analysis of the second primary outcome, days to recovery, will be per protocol using a linear regression model and a non-inferiority margin of 1 day.Ethics and disseminationThe study was approved on 18 June 2021 by the Ethics Committee (ref: no. 1) of the National Centre of Maternity and Childhood Care, Bishkek, Kyrgyzstan. The results of the study regardless of the conclusion will be presented at international conferences and published in peer-reviewed scientific medical journals along with policy briefs and technical reports.Trial registration numberNCT05195866.

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What are the effects of using C-reactive protein (CRP) to guide antibiotic prescribing for adults with acute respiratory infection in primary care?

Burch¹,

Martin²

2018

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Biomarkers as point-of-care tests to guide prescription of antibiotics in people with acute respiratory infections in primary care

Abstract: Biomarkers as point-of-care tests to guide prescription of antibiotics in people with acute respiratory infections in primary care.

Cited by 25 publications

References 129 publications

Point-of-care measurement of C-reactive protein promotes de-escalation of treatment decisions and strengthens the perceived clinical confidence of physicians in out-of-hours outpatient emergency medical services

Point-of-care measurement of C-reactive protein promotes de-escalation of treatment decisions and strengthens the perceived clinical confidence of physicians in out-of-hours outpatient emergency medical services

C reactive protein-guided prescription of antibiotics for children under 12 years with respiratory symptoms in Kyrgyzstan: protocol for a randomised controlled clinical trial with 14 days follow-up

What are the effects of using C-reactive protein (CRP) to guide antibiotic prescribing for adults with acute respiratory infection in primary care?

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