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

Abstract

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).

Outpatient Management of Acute Respiratory Infections in Children

“…В снижение частоты необоснованной антибактериальной терапии при инфекциях дыхательных путей существенный вклад вносит возможность лабораторной экспресс-диагностики. Исследование уровня лейкоцитов у детей с лихорадкой и симптомами респираторной инфекции длительностью не менее 48 ч и исследование С-реактивного белка в сыворотке крови значительно снижают риск назначения АБП при первичной консультации [21,22]. Стоит отметить, что для достижения положительного влияния лабораторных исследований на амбулаторное лечение респираторных инфекций необходимо проведение обучения врачей интерпретации результатов исследования, так как часто cut-off-уровень (пороговое значение) для исключения возможного бактериального воспаления не совпадает с референсными значениями анализов.…”

An Overview of Emerging Point-of-Care Tests for Differentiating Bacterial and Viral Infections

“…Evidence from these systematic reviews on immediate antibiotic prescribing showed that POC tests for CRP were associated with a risk ratio of 0.81 (95% CI, 0.71 to 0.92) 27 in ambulatory care settings (i.e., outpatient settings, walk-in clinics, or emergency departments) and a risk ratio of 0.79 (95% CI, 0.70 to 0.90) 54 in primary care settings more generally. Therefore, POC tests for CRP likely reduce antibiotic prescribing at the point where people seek care compared with usual care without a POC test.…”

Paediatric Antimicrobial Stewardship for Respiratory Infections in the Emergency Setting: A Systematic Review

“…Inappropriate rates of antibiotic prescription have been observed across several healthcare settings, from primary to secondary care, with a particular focus being placed on primary care [ 8 ]. Several studies have shown promise with regards to the use of ASP interventions in the primary care setting [ 9 , 10 , 11 ]. Further, recent reviews exploring paediatric ASPs in both inpatient and outpatient settings have observed the potential of these interventions in reducing antimicrobial use, healthcare costs and AMR [ 12 ].…”