Antibiotic selection patterns in acutely febrile new outpatients with or without immediate testing for C reactive protein and leucocyte count

Abstract

Background: Excessive use of broad spectrum antibiotics is related to the spread of drug resistant bacterial strains in the community. Aim/methods: The effects of immediate testing for C reactive protein (CRP) and white blood cell count (WBC) on physicians' choices of antibiotic was investigated in patients with acute infection. Acutely febrile new outpatients were randomised into two groups: group 1 (147 patients) underwent CRP and WBC testing before initial consultation (advance testing). Prescriptions were compared with those in group 2 (no advance testing; 154 patients).Results: In non-pneumonic acute respiratory tract infections, 61 (58%) and 122 (91%) of group 1 and 2 patients were prescribed antibiotics, respectively. Cefcapene pivoxil (third generation cephalosporin) and amoxicillin were the most frequently chosen drugs for group 1 and 2, respectively. Total prescriptions of newer, extended spectrum antibiotics (cefcapene pivoxil and clarithromycin (advanced macrolide)) were reduced by 25% in group 1, although they increased in rate (41 (67%) v 55 (45%) prescriptions) because of the decreased prescription of amoxicillin. In group 1, cefcapene pivoxil was preferentially selected when WBC values were greater than 9 6 10 9 /litre. Prescription shifted to macrolides (mainly clarithromycin) in patients without leucocytosis. Patient treatment outcome did not significantly differ between the two groups. Conclusions: The availability of CRP and WBC data during initial consultation greatly reduced prescription of amoxicillin, but had a lesser effect on newer, potent, broad spectrum antibiotics.

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

“…After full-text evaluation, 152 publications were relevant for POCT. After excluding 34 publications [ 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 ] ( Supplementary Materials ), 13 studies [ 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 ] reported across 22 publications [ 61 , 62 , 63 …”

“…The 13 studies comprised a total of 9844 randomised patients ( Table 1 ); nine individually randomised 4529 patients to intervention groups [ 61 , 63 , 64 , 65 , 68 , 69 , 71 , 72 , 73 ], and four randomised 226 sites and/or 173 physicians with 5315 patients [ 62 , 66 , 67 , 70 ]. Six studies included adult patients only [ 66 , 67 , 68 , 69 , 70 , 73 ], four included children only [ 61 , 62 , 63 , 64 ], two included both adults and children [ 65 , 72 ], and one did not distinguish age groups [ 71 ]. Participants had a mean age of 26.4 (SD 15.0) (range: 0–90) years, and 43.9% were male.…”

“…The ethnicity of patients was reported in only one study as follows: black (46%), white (25%), or other (29%) [ 68 ]. Physician characteristics were reported in two studies [ 70 , 71 ]: they were 29–53 years old; had 5–29 years of experience; and in one study, 60% were male [ 70 ].…”

C-Reactive Protein Testing Does Not Decrease Antibiotic Use for Acute Cough Illness When Compared to a Clinical Algorithm

“…In a study among general practitioners in Denmark, there was no effect of CRP testing on overall antibiotic prescription rates for ARIs (with CRP 45% vs. without CRP 43%) (16). However, in a Japanese trial of outpatients with febrile ARIs, the combination of CRP and white blood cell measurement was associated with a much lower antibiotic prescription rate compared with usual care (CRP 55% vs. control 88%) (17). In Switzerland, procalcitonin testing was associated with a significant reduction in antibiotic treatment among adults seeking ED evaluation for acute cough illness (18).…”

The Future of Point–of–Care Testing Using C-Reactive Protein – An Ideal Tool for Diagnosis, Prognosis and Therapy Management

“…This is highly applicable when dealing with virus infections or selflimiting bacterial upper respiratory tract infections, acute bronchitis and influenza. 7,8 These measures would enable a more targeted therapeutic approach reducing the risk of acquiring antibiotic resistance.…”