Out-of-hours antibiotic prescription after screening with C reactive protein: a randomised controlled study

Abstract

ObjectiveTo evaluate the effect of preconsultation C reactive protein (CRP) screening on antibiotic prescribing and referral to hospital in Norwegian primary care settings with low prevalence of serious infections.DesignRandomised controlled observational study at out-of-hours services in Norway.SettingPrimary care.Participants401 children (0–6 years) with fever and/or respiratory symptoms were recruited from 5 different out-of-hours services (including 1 paediatric emergency clinic) in 2013–2015.InterventionData were collected from questionnaires and clinical examination results. Every third child was randomised to a CRP test before the consultation; for the rest, the doctor ordered a CRP test if considered necessary.Outcome measuresMain outcome variables were prescription of antibiotics and referral to hospital.ResultsIn the group pretested with CRP, the antibiotic prescription rate was 26%, compared with 22% in the control group. In the group pretested with CRP, 5% were admitted to hospital, compared with 9% in the control group. These differences were not statistically significant. The main predictors for ordering a CRP test were parents' assessment of seriousness of the illness and the child's temperature. Paediatricians ordered CRP tests less frequently than did other doctors (9% vs 56%, p<0.001).ConclusionsPreconsultation screening with CRP of children presenting to out-of-hours services with fever and/or respiratory symptoms does not significantly affect the prescription of antibiotics or referral to hospital.Trial registration numberNCT02496559; Results.

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.…”

“…CRP-POCT was performed by physicians [ 61 , 62 , 63 , 65 , 66 , 67 , 70 , 71 , 72 , 73 ] or nurses [ 64 , 68 , 69 ] ( Table 1 ). Nine studies reported training in the intervention, which consisted of instructions on CRP devices, guidelines for the use of CRP, and/or management of RTIs [ 62 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 72 ]. In 11 studies, clinicians also received guidance or information for the interpretation of CRP results in terms of disease severity, antibiotic prescribing, or both.…”

“…One study used a 2 × 2 factorial design and combined intervention groups, including the effect of enhanced communication skills training (CST), to both CRP-POCT and usual care [ 70 ]. Usual care was described as a clinical assessment as usual with CRP not tested [ 61 , 63 , 64 , 72 , 73 ] or as routine practice according to normal procedures with/out access to other investigations [ 65 , 68 , 69 , 70 , 71 , 78 ]. However, CRP-POCT could have also been performed if patients in the usual care group were at clinical risk or if the results of physical examinations suggested it to be necessary [ 62 , 66 ].…”

Rapid Tests for Influenza, Respiratory Syncytial Virus, and Other Respiratory Viruses: A Systematic Review and Meta-analysis

“…Clinical signs and symptoms of viral RTIs overlap with those of bacterial infections. It is challenging to clinically distinguish bacterial from viral infections and different viral pathogens [7]. This diagnostic uncertainty leads to overprescription of antibiotics and extra diagnostic testing (along with costs) to rule out bacterial infections [8,9].…”