The Use of CRP Tests in Patients with Respiratory Tract Infections in Primary Care in Sweden Can Be Questioned

Abstract

A diagnosis-antibiotic prescribing study was performed in 5 counties in Sweden during 1 week in November in 2000 and 2002 respectively. As a part of the study, the use and results of C-reactive protein (CRP) tests in relation to duration of symptoms and antibiotic prescribing in 6778 patients assigned a diagnosis of respiratory tract infections were analysed. In almost half (42%) of the patients, a CRP test was performed. The majority of CRP tests (69%) were performed in patients assigned diagnosis upper respiratory tract infection, where the test is not recommended. Overall, there was a minor decrease in antibiotic prescribing when CRP was used (41%), in comparison to 44% of the patients where no CRP was performed (p < 0.01). Patients assigned diagnoses implying a bacterial aetiology were prescribed antibiotics irrespective of result of CRP or length of symptoms before consultation. For patients assigned viral diagnoses, antibiotic prescribing increased with increasing duration of symptoms and increasing value of CRP. The use of CRP decreased antibiotic prescribing in patients assigned to viral diagnoses and with longstanding symptoms (p < 0.001). However, 59% of the patients assigned viral diagnoses with CRP > or = 25 received antibiotics, which seems to indicate a misinterpretation of CRP and a non-optimal use of antibiotics.

Diarrhea in Preschool Children and Lactobacillus reuteri: A Randomized Controlled Trial

“…Secondary outcomes were (1) days with a respiratory tract infection (RTI), defined by using international published definitions, 11,12 (2) days of absence from day care caused by an episode of diarrhea or RTI, (3) days of antibiotic use caused by an episode of diarrhea or RTI, (4) days of medical office or emergency visits caused by an episode of diarrhea or RTI, and (5) total direct and indirect costs to the hospital and to parents/guardians during the study caused by diarrhea and/or RTI. The primary and secondary outcomes were reported for the intervention period (0-12 weeks) and for the followup period after intervention had stopped (12-24 weeks).…”

Antibiotics and near-patient testing: Differences in habits between physicians completing or discontinuing a medical audit

“…C-reactive protein (CRP) is recommended in lower RTIs when pneumonia cannot be clinically excluded [10]. The high use of Strep-A and CRP in Sweden has been questioned [11].…”

Should We Use the Point-of-Care for Testing C-Reactive Protein in Order to Diagnose the Respiratory Tract Infection in Primary Health Care?

“…С одной стороны, возможно избы-точное назначение антибиотиков при остром брон-хите, который в 90% случаев является вирусным, с другой стороны -опасность не назначить ан-тибиотик при пневмонии, которая может быть крайне тяжелой, угрожающей жизни [6][7][8].…”

“…Концентрация СРБ в крови значи-тельно повышается во время инфекций, и высокие значения (выше 100 мг/л) типичны для таких тяжелых бактериальных инфекций, как пневмо-ния. При вирусных инфекциях обычно выявля-ются умеренно повышенные значения (от 10 до 100 мг/л) при длительности заболевания 3-4 дня [8,13,14]. Антибиотики можно не назначать при низких значениях СРБ (ниже 10 мг/л), но необ-ходимо принимать во внимание продолжитель-ность течения заболевания [14].…”

“…Так, в Норвегии этот тест используется примерно в 15% всех консуль-таций в общей врачебной практике, а в Швеции -у 31-41% пациентов с инфекциями дыхательных путей и в 60% случаев, когда инфекция нижних дыхательных путей предполагается [8,15].…”