C-reactive protein point-of-care testing and associated antibiotic prescribing

BackgroundPoint-of-care C-reactive protein (CRP) testing of adults with acute respiratory infection in primary care reduces antibiotic prescribing by 22%. The acceptability and impact of CRP testing in children is unknownObjectiveTo determine the acceptability and impact of CRP testing in acutely ill children.DesignMixed methods study comprising an observational cohort with a nested randomised controlled trial and embedded qualitative study.Subjects and settingChildren presenting with an acute illness to general practice out-of-hours services; children with a temperature ≥38°C were randomised in the nested trial; parents and clinical staff were invited to the qualitative study.Main outcomesInformed consent rates; parental and staff views on testing.ResultsConsent to involvement in the study was obtained for 200/297 children (67.3%, 95% CI 61.7% to 72.6%); the finger-prick test might have been a contributory factor for 63 of the 97 children declining participation but it was cited as a definite factor in only 10 cases. None of the parents or staff raised concerns about the acceptability of testing, describing the pain caused as minor and transient. General practitioner views on the utility of the CRP test were inconsistent.ConclusionsCRP point-of-care testing in children is feasible in primary care and is likely to be acceptable. However, it will not reduce antibiotic prescribing and hospital referrals until general practitioners accept its diagnostic value in children.Trial registration numberISRCTN 69736109.

Download Full-text

C-reactive protein point of care testing: the answer to antibiotic prescribing in ambulatory patients with exacerbations of chronic obstructive pulmonary disease?

Expert Review of Respiratory Medicine ◽

10.1080/17476348.2020.1776611 ◽

2020 ◽

pp. 1-3

Author(s):

Carl Llor ◽

Marc Miravitlles

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Point Of Care ◽

Chronic Obstructive ◽

Antibiotic Prescribing ◽

Point Of Care Testing ◽

C Reactive Protein ◽

Obstructive Pulmonary Disease ◽

Reactive Protein ◽

Ambulatory Patients

Download Full-text

Point-of-care testing for C-reactive protein in acute cough presentations in primary care

Journal of Paramedic Practice ◽

10.12968/jpar.2020.12.1.cpd1 ◽

2020 ◽

Vol 12 (1) ◽

pp. 1-7

Author(s):

Simon Searle-Barnes ◽

Peter Phillips

Keyword(s):

Primary Care ◽

Point Of Care ◽

Point Of Care Testing ◽

C Reactive Protein ◽

Acute Cough ◽

Reactive Protein ◽

The United Kingdom ◽

Viral Aetiology ◽

Prescription Rates ◽

The Uk

Acute cough is one of the most common illnesses in the UK, with an estimated 48 million cases per annum. The majority of these presentations are thought to be of viral aetiology and self-limiting in nature, yet some studies report antibiotic prescription rates of approximately 65% in the UK. Clincians' decision-making process can be influenced by both patient expectations and difficulty in differentiating between viral and bacterial aetiologies by clinical examination alone. This article will consider the feasibility, efficacy, benefits and limitations of using point-of-care testing of C-reactive protein within primary care in the United Kingdom to help inform management of acute cough.

Download Full-text

C-reactive protein point-of-care testing for lower respiratory tract infections: a qualitative evaluation of experiences by GPs

Family Practice ◽

10.1093/fampra/cmp088 ◽

2009 ◽

Vol 27 (2) ◽

pp. 212-218 ◽

Cited By ~ 50

Author(s):

J. W L Cals ◽

F. H F Chappin ◽

R. M Hopstaken ◽

M. E van Leeuwen ◽

K. Hood ◽

...

Keyword(s):

Respiratory Tract ◽

Lower Respiratory Tract ◽

Respiratory Tract Infections ◽

Point Of Care ◽

Qualitative Evaluation ◽

Point Of Care Testing ◽

C Reactive Protein ◽

Lower Respiratory Tract Infections ◽

Reactive Protein ◽

Tract Infections

Download Full-text

Point-of-Care C-Reactive Protein Testing to Reduce Antibiotic Prescribing for Respiratory Tract Infections in Primary Care: Systematic Review and Meta-Analysis of Randomised Controlled Trials

Antibiotics ◽

10.3390/antibiotics9090610 ◽

2020 ◽

Vol 9 (9) ◽

pp. 610

Author(s):

Nahara Anani Martínez-González ◽

Ellen Keizer ◽

Andreas Plate ◽

Samuel Coenen ◽

Fabio Valeri ◽

...

Keyword(s):

Primary Care ◽

Respiratory Tract ◽

Usual Care ◽

Respiratory Tract Infections ◽

Point Of Care ◽

Antibiotic Prescribing ◽

C Reactive Protein ◽

Reactive Protein ◽

Meta Analyses ◽

Tract Infections

C-reactive protein (CRP) point-of-care testing (POCT) is increasingly being promoted to reduce diagnostic uncertainty and enhance antibiotic stewardship. In primary care, respiratory tract infections (RTIs) are the most common reason for inappropriate antibiotic prescribing, which is a major driver for antibiotic resistance. We systematically reviewed the available evidence on the impact of CRP-POCT on antibiotic prescribing for RTIs in primary care. Thirteen moderate to high-quality studies comprising 9844 participants met our inclusion criteria. Meta-analyses showed that CRP-POCT significantly reduced immediate antibiotic prescribing at the index consultation compared with usual care (RR 0.79, 95%CI 0.70 to 0.90, p = 0.0003, I2 = 76%) but not during 28-day (n = 7) follow-up. The immediate effect was sustained at 12 months (n = 1). In children, CRP-POCT reduced antibiotic prescribing when CRP (cut-off) guidance was provided (n = 2). Meta-analyses showed significantly higher rates of re-consultation within 30 days (n = 8, 1 significant). Clinical recovery, resolution of symptoms, and hospital admissions were not significantly different between CRP-POCT and usual care. CRP-POCT can reduce immediate antibiotic prescribing for RTIs in primary care (number needed to (NNT) for benefit = 8) at the expense of increased re-consultations (NNT for harm = 27). The increase in re-consultations and longer-term effects of CRP-POCT need further evaluation. Overall, the benefits of CRP-POCT outweigh the potential harms (NNTnet = 11).

Download Full-text