Use of point-of-care tests and antibiotic prescribing in sore throat and lower respiratory infections by general practitioners

Llor, Carles; Molero, José; Moragas, Ana; Córdoba, Gloria; Bjerrum, Lars

doi:10.1016/j.eimc.2019.02.005

Cited by 4 publications

(4 citation statements)

References 10 publications

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“…In an audit-based study aimed at assessing GPs’ reliance on patient history, examination findings and the influence of the utilisation of POCTs in antibiotic prescribing for sore throat and LRTI, a negative POCT result was negatively associated with antibiotic prescribing and GPs using POCTs attached less weight to clinical criteria. 44 …”

Section: Resultsmentioning

confidence: 99%

“…43 In an audit-based study aimed at assessing GPs' reliance on patient history, examination findings and the influence of the utilisation of POCTs in antibiotic prescribing for sore throat and LRTI, a negative POCT result was negatively associated with antibiotic prescribing and GPs using POCTs attached less weight to clinical criteria. 44 In a small feasibility study, patients who would have received antibiotics for RTI were referred by a GP practice to a local pharmacy for CRP POCT. Patients who had a CRP of less than 100 were given a leaflet and told to visit the GP if symptoms did not resolve within 3 weeks.…”

Section: Open Accessmentioning

confidence: 99%

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Respiratory tract infections (RTIs) in primary care: narrative review of C reactive protein (CRP) point-of-care testing (POCT) and antibacterial use in patients who present with symptoms of RTI

et al. 2020

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Antimicrobial resistance (AMR) continues to be a global problem and continues to be addressed through national strategies to improve diagnostics, develop new antimicrobials and promote antimicrobial stewardship. Patients who attend general (ambulatory) practice with symptoms of respiratory tract infections (RTIs) are invariably assessed by some sort of clinical decision rule (CDR). However, CDRs rely on a cluster of non-specific clinical observations. A narrative review of the literature was undertaken to ascertain the value of C reactive protein (CRP) point-of-care testing (POCT) to guide antibacterial prescribing in adult patients presenting to general practitioner (GP) practices with symptoms of RTI. Studies that were included were Cochrane reviews, systematic reviews, randomised controlled trials, cluster randomised trials, controlled before and after studies, cohort studies and economic evaluations. An overwhelming number of studies demonstrated that the use of CRP tests in patients presenting with RTI symptoms reduces index antibacterial prescribing. GPs and patients report a good acceptability for a CRP POCT and economic evaluations show cost-effectiveness of CRP POCT over existing RTI management in primary care. POCTs increase diagnostic precision for GPs in the better management of patients with RTI. With the rapid development of artificial intelligence, patients will expect greater precision in diagnosing and managing their illnesses. Adopting systems that markedly reduce antibiotic consumption is a no-brainer for governments that are struggling to address the rise in AMR.

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Section: Resultsmentioning

confidence: 99%

Section: Open Accessmentioning

confidence: 99%

Respiratory tract infections (RTIs) in primary care: narrative review of C reactive protein (CRP) point-of-care testing (POCT) and antibacterial use in patients who present with symptoms of RTI

et al. 2020

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“…Inappropriate antibiotic prescribing is linked to a risk of antibiotic resistance [ 1 ]. Point-of-care (POC) testing may reduce diagnostic uncertainty [ 2 ], thereby contributing to prudent antibiotic prescribing [ 3 , 4 ]. Point-of-care tests are medical diagnostic tests performed at or near the site of care [ 5 ], such as measurement of C-reactive protein (CRP), enzyme immunoassay kits (e.g.…”

Section: Introductionmentioning

confidence: 99%

Point-of-care testing and antibiotics prescribing in out-of-hours general practice: a register-based study in Denmark

Christensen,

Vestergaard,

Keizer

et al. 2024

BMC Prim. Care

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Background Point-of-care testing may reduce diagnostic uncertainty in case of suspicion of bacterial infection, thereby contributing to prudent antibiotic prescribing. We aimed to study variations in the use of point-of-care tests (C-reactive protein test, rapid streptococcal antigen detection test, and urine dipstick) among general practitioners (GPs) and the potential association between point-of-care testing and antibiotic prescribing in out-of-hours general practice. Methods We conducted a population-based observational register-based study, based on patient contacts with out-of-hours general practice in the Central Denmark Region in 2014–2017. The tendency of GPs to use point-of-care testing was calculated, and the association between the use of point-of-care testing and antibiotic prescribing was evaluated with the use of binomial regression. Results Out-of-hours general practice conducted 794,220 clinic consultations from 2014 to 2017, of which 16.1% resulted in an antibiotic prescription. The GP variation in the use of point-of-care testing was largest for C-reactive protein tests, with an observed variation (p90/p10 ratio) of 3.0; this means that the GPs in the 90th percentile used C-reactive protein tests three times as often as the GPs in the 10th percentile. The observed variation was 2.1 for rapid streptococcal antigen detection tests and 1.9 for urine dipsticks. The GPs who tended to use more point-of-care tests prescribed significantly more antibiotics than the GPs who tended to use fewer point-of-care tests. The GPs in the upper quintile of the tendency to use C-reactive protein test prescribed 22% more antibiotics than the GPs in the lowest quintile (21% for rapid streptococcal antigen detection tests and 8% for urine dipsticks). Up through the quintiles, this effect exhibited a positive linear dose–response correlation. Conclusion The GPs varied in use of point-of-care testing. The GPs who tended to perform more point-of-care testing prescribed more antibiotics compared with the GPs who tended to perform fewer of these tests.

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“…POCTs could not only improve the use of antibiotics but also reduce patient pressure for antibiotic prescriptions [9]. In a study by Llor et al, general practitioners in Spain were strongly influenced by POCT results in the decision to prescribe antibiotics [10]. Gunnarsson et al, reported that in Australia, 40% of patients with uncomplicated acute sore throat who were prescribed antibiotics had bacterial AP before testing, while this proportion increased to 97% after testing [11].…”

Section: Introductionmentioning

confidence: 99%

Reducing Antibiotic Misuse through the Use of Point-of-Care Tests in Germany: A Survey of 1257 Medical Practices

Peiter,

Haering,

Bradic

et al. 2023

Healthcare

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Though more than 80% of acute pharyngitis (AP) cases have a viral etiology, it remains one of the most common causes for the unnecessary prescription of antibiotics (ABs). Half of patients receive antibiotics in general practice. Point-of-Care Tests (POCTs) distinguish between bacterial and viral pharyngitis. The objective of this study was to evaluate the use of POCTs using throat swabs to detect β-Streptococcus pyogenes Group A (strep A) infection among patients with sore throat/acute pharyngitis in primary care practices across Germany. A study was conducted in 1257 primary care practices. Two questionnaires were administered concerning frequency, POCT results and whether antibiotics were prescribed. Of the 1257 physicians, 60% used POCTs. Of these, 25% used a POCT before prescribing an antibiotic, 39% in cases of severe sore throat, 40% in cases of long-lasting pharyngitis and 25% in other cases. In total, 83% considered the adoption of POCTs in everyday practice to be important or very important for the diagnosis of strep A, 90% considered it important or very important for achieving a more sensible use of antibiotics and the prevention of bacterial resistance and 80% considered it important or very important for justifying to patients whether or not an antibiotic is needed. POCT results and information on AB prescriptions were available for 583 patients. Of these, 22.5% tested positive for strep A, and 21.8% were prescribed antibiotics. Our study shows that the use of swab tests in patients with sore throat in primary care practices results in high levels of physician satisfaction and can strongly reduce the misuse of antibiotics in clinical practice.

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Use of point-of-care tests and antibiotic prescribing in sore throat and lower respiratory infections by general practitioners

Cited by 4 publications

References 10 publications

Respiratory tract infections (RTIs) in primary care: narrative review of C reactive protein (CRP) point-of-care testing (POCT) and antibacterial use in patients who present with symptoms of RTI

Respiratory tract infections (RTIs) in primary care: narrative review of C reactive protein (CRP) point-of-care testing (POCT) and antibacterial use in patients who present with symptoms of RTI

Point-of-care testing and antibiotics prescribing in out-of-hours general practice: a register-based study in Denmark

Reducing Antibiotic Misuse through the Use of Point-of-Care Tests in Germany: A Survey of 1257 Medical Practices

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