Immediate Availability of C-Reactive Protein and Leukocyte Count Data Influenced Physicians’ Decisions to Prescribe Antimicrobial Drugs for New Outpatients with Acute Infections

Takemura, Y; Kakoi, Hideo; Ishida, Hideyuki; Kure, Hideki; Tatsuguchi-Harada, Yuriko; Sugawara, Masafumi; Inoue, Yoshio; Ebisawa, Ken; Kure, Morimitsu

doi:10.1373/clinchem.2003.021956

Cited by 11 publications

(7 citation statements)

References 14 publications

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“…Complete blood count (CBC) including WBC differential and C‐reactive protein (CRP) have been frequently utilized as the biomarkers for inflammatory diseases such as bacterial infection . Generally, CBC including WBC differential has been examined using whole blood anticoagulated with ethylenediaminetetraacetic acid (EDTA) .…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the Microsemi CRP, an automated hematology analyzer for rapid 3‐part WBC differential and CRP using whole blood

Nomura

Saito

Ikeda

et al. 2014

Int J Lab Hematology

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Section: Introductionmentioning

confidence: 99%

Evaluation of the Microsemi CRP, an automated hematology analyzer for rapid 3‐part WBC differential and CRP using whole blood

Nomura

Saito

Ikeda

et al. 2014

Int J Lab Hematology

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“…Estimation of C-reactive protein (CRP), leukocyte and white blood cell (WBC) count may assist in differentiating bacterial vs. viral infections. Patients with acute bacterial infections typically have a markedly increased CRP and WBC count compared to patients with viral infection [23]. C-reactive protein estimation is not routinely performed, but leukocyte count is more readily available, although only 63.8% of patients had a WBC count before the start of antimicrobial therapy.…”

Section: Discussionmentioning

confidence: 99%

Prescribing patterns and utilization of antimicrobial drugs in a tertiary care teaching hospital of a Caribbean developing country

Subramanian

Pillai

McIntosh

et al. 2009

Fundamemntal Clinical Pharma

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This study aimed to evaluate the prescribing practices and utilization of antimicrobials in a tertiary care teaching hospital of a Caribbean developing country. A prospective observational cohort study was undertaken for a period of 12 weeks in the general wards and the intensive care unit (ICU) of the hospital. Demographic data, diagnoses on admission, antimicrobials prescribed, dosage and duration, route of administration, leukocyte count and microbiological culture and sensitivity reports were recorded. Hospital length of stay and final outcome were recorded. The usage was determined in terms of prescribed daily dose and the total costs of antimicrobials were calculated. Of 889 patients admitted, 335 (37.7%) received 22 different antimicrobial drugs. Overall, 67% of the prescriptions adhered to the hospital protocol. Median length of stay in the hospital was 7 days. Skin and soft tissue infections were the most common diagnoses for which antimicrobials were prescribed. Amoxicillin-clavulanate was the most common (32%) antimicrobial used. Eighty-nine percent of the antimicrobials were given through the intravenous route. Sixty percent of the patients received two antimicrobials, 26% received three, and 14% of patients were prescribed four or more antimicrobials during their stay at the hospital. There was significantly higher inappropriate choice of antimicrobials in ICU when compared with general wards (Mantel-Haenszel Odds Ratio 3.3; 95% Confidence Intervals 1.4, 7.7). Prescribing patterns did not strictly adhere to the hospital antimicrobial protocol. There is a need for monitoring and control of antimicrobial prescription.

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“…Between run imprecision (coefficient of variation) ranged from 3.3% to 6.3% at 5-22 mg/litre for CRP and from 5.3% to 5.9% at 2.5-6.8 6 10 9 / litre for WBC. 21 The reference intervals used by physicians were ( 5 mg/litre for CRP and 3.5-9.0 6 10 9 /litre for WBC.…”

Section: Methodsmentioning

confidence: 99%

“…21 Three patients in the advance testing group required hospitalisation at the initial visit (two patients) or at reconsultation (one patient), and two patients in the other group were admitted at the initial visit. lists the clinical diagnoses obtained from history taking and physical examination with or without CRP and WBC test results (and/or other urgent tests when deemed necessary).…”

Section: Clinical Diagnosis and Antibiotic Usementioning

confidence: 99%

“…[18][19][20] Furthermore, immediate availability of CRP and WBC data during initial consultation has certainly decreased antibiotic prescriptions. 21 Therefore, immediate test result notification might be an effective means of altering physicians' prescribing decisions. In addition, it is of interest to analyse the influence of immediate testing on physician's antibiotic choices, in connection with the appropriate usage of antibiotics.…”

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confidence: 99%

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

Takemura

Ebisawa²,

Kakoi³

et al. 2005

J Clin Pathol

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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.

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Immediate Availability of C-Reactive Protein and Leukocyte Count Data Influenced Physicians’ Decisions to Prescribe Antimicrobial Drugs for New Outpatients with Acute Infections

Cited by 11 publications

References 14 publications

Evaluation of the Microsemi CRP, an automated hematology analyzer for rapid 3‐part WBC differential and CRP using whole blood

Evaluation of the Microsemi CRP, an automated hematology analyzer for rapid 3‐part WBC differential and CRP using whole blood

Prescribing patterns and utilization of antimicrobial drugs in a tertiary care teaching hospital of a Caribbean developing country

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

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