C-reactive protein: guiding antibiotic prescribing decisions at the point of care

Cals, Jochen; Ebell, Mark H.

doi:10.3399/bjgp18x694901

Cited by 14 publications

(11 citation statements)

References 19 publications

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“…A recent editorial by Cals and Ebell discussed how the CRP test might be incorporated into clinical decision rules by combining the test result with symptoms and findings. 26 Correspondingly, the authors found that older patients and those with a fever, dyspnoea, abnormal lung auscultation, ear/facial pain, and those with a poor general appearance were prescribed antibiotics at lower CRP levels than other patients.…”

Section: Discussionmentioning

confidence: 95%

“…Importantly, most studies on the use of CRP tests in patients with acute RTIs have been performed in patients with acute cough, and solid evidence is lacking for its use in patients with other infections. 26 …”

Section: Discussionmentioning

confidence: 99%

“…However, 'the upper value' in support of antibiotic treatment differ between guidelines. Importantly, most studies on the use of CRP tests in patients with acute respiratory tract infections have been performed in patients with acute cough, and solid evidence is lacking for its use in patients with other infections (26).…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

“…In a recent editorial by Cals and Ebell it is discussed how the CRP test might be incorporated into clinical decision rules by combining the test result with symptoms and findings (26).…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

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C-reactive protein cut-offs used for acute respiratory infections in Danish general practice

et al. 2020

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Background: General practitioners (GPs) can use C-reactive protein (CRP) point-of-care test to assist when deciding whether to prescribe antibiotics for patients with acute respiratory tract infections (RTIs). Aim: To estimate which CRP cut-off levels Danish GPs use to guide antibiotic prescribing for patients presenting with different signs and symptoms of RTIs. Design and setting: Cross-sectional study. General practice in Denmark. Methods: During winter 2017 and 2018, 143 GPs and their staff registered consecutive patients with symptoms of an RTI according to the Audit Project Odense method. CRP cut-offs were estimated as the lowest level at which half of the patients were prescribed an antibiotic. Results: In total, 7,813 patients were diagnosed with an RTI of whom 4,617 (59%) had a CRP test performed. At least 25% of the patients were prescribed an antibiotic when the CRP level was above 20 mg/L, at least 50% when CRP was above 40 mg/L, and at least 75% when CRP was above 50 mg/L. Lower thresholds were identified for patients aged 65 years and those presenting with a fever, poor general appearance, dyspnoea, abnormal lung auscultation or ear/facial pain - and if the duration of symptoms was either short (≤1 day) or long (>14 days). Conclusion: More than half of patients presenting to Danish general practice with symptoms of an RTI have a CRP test performed. At CRP-levels above 40 mg/L the majority of patients have an antibiotic prescribed.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Comparison With Existing Literaturementioning

confidence: 99%

“…In a recent editorial by Cals and Ebell it is discussed how the CRP test might be incorporated into clinical decision rules by combining the test result with symptoms and findings (26).…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

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C-reactive protein cut-offs used for acute respiratory infections in Danish general practice

et al. 2020

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“…Numerous biomarkers to identify bacterial infections have been proposed [19], but none have perfect sensitivity and specificity. The most studied is C-reactive protein (CRP), a marker of inflammation that has been in clinical use for decades [20]. While in some populations it has underperformed, particularly at the severe end of the clinical spectrum [21], in many studies CRP has been found to be appropriately sensitive and moderately specific to identify patients with a bacterial infection [22, 23].…”

Section: Introductionmentioning

confidence: 99%

Economic considerations support C-reactive protein testing alongside malaria rapid diagnostic tests to guide antimicrobial therapy for patients with febrile illness in settings with low malaria endemicity

Lubell

Chandna

Smithuis

et al. 2019

Malar J

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Malaria is no longer a common cause of febrile illness in many regions of the tropics. In part, this success is a result of improved access to accurate diagnosis and effective anti-malarial treatment, including in many hard-to-reach rural areas. However, in these settings, management of other causes of febrile illness remains challenging. Health systems are often weak and other than malaria rapid tests no other diagnostics are available. With millions of deaths occurring annually due to treatable bacterial infections and the ever increasing spread of antimicrobial resistance, improvement in the management of febrile illness is a global public health priority. Whilst numerous promising point-of-care diagnostics are in the pipeline, substantial progress can be made in the interim with existing tools: C-reactive protein (CRP) is a highly sensitive and moderately specific biomarker of bacterial infection and has been in clinical use for these purposes for decades, with dozens of low-cost devices commercially available. This paper takes a health-economics approach to consider the possible advantages of CRP point-of-care tests alongside rapid diagnostic tests for malaria, potentially in a single multiplex device, to guide antimicrobial therapy for patients with febrile illness. Three rudimentary assessments of the costs and benefits of this approach all indicate that this is likely to be cost-effective when considering the incremental costs of the CRP tests as compared with either (i) the improved health outcomes for patients with bacterial illnesses; (ii) the costs of antimicrobial resistance averted; or (iii) the economic benefits of better management of remaining malaria cases and shorter malaria elimination campaigns in areas of low transmission. While CRP-guided antibiotic therapy alone cannot resolve all challenges associated with management of febrile illness in remote tropical settings, in the short-term a multiplexed CRP and malaria RDT could be highly cost-effective and utilize the well-established funding and distribution systems already in place for malaria RDTs. These findings should spark further interest amongst industry, academics and policy-makers in the development and deployment of such diagnostics, and discussion on their geographically appropriate use.

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

Smedemark

Llor

Aabenhus

et al. 2022

Cochrane Database of Systematic Reviews

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C-reactive protein: guiding antibiotic prescribing decisions at the point of care

Abstract: ProvenanceCommissioned; not externally peer reviewed.

Cited by 14 publications

References 19 publications

C-reactive protein cut-offs used for acute respiratory infections in Danish general practice

C-reactive protein cut-offs used for acute respiratory infections in Danish general practice

Economic considerations support C-reactive protein testing alongside malaria rapid diagnostic tests to guide antimicrobial therapy for patients with febrile illness in settings with low malaria endemicity

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

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