Can C-reactive protein testing reduce antibiotic overprescribing?

January 01, 0001

Can C-reactive protein testing reduce antibiotic overprescribing?

Overprescribing antibiotics is a significant issue in family medicine. Lower respiratory tract infections (LRTI) and rhinosinusitis are two settings in which overprescribing occurs. C-reactive protein (CRP) point- of-care testing and delayed prescribing are strategies to reduce antibiotic prescribing, but both have limitations. These Dutch researchers evaluated the effect of CRP assistance in antibiotic prescribing strategies by conducting a randomized controlled trial involving LRTI and rhinosinusitis. Patients (n=258, 107 LRTI and 151 rhinosinusitis) were individually randomized to CRP assistance or routine care (control).

The researchers report: "Patients in the CRP-assisted group used fewer antibiotics (43.4%) than control patients (56.6%) after the index consultation (RR = 0.77). This difference remained significant during follow-up (52.7% vs 65.1%, RR = 0.81). Delayed prescriptions in the CRP-assisted group were filled only in a minority of cases (23% vs 72% in control group). Recovery was similar across groups. Satisfaction with care was higher in patients managed with CRP assistance."

The researchers concluded: "CRP point-of-care testing to assist in prescribing decisions, including delayed prescribing, for LRTI and rhinosinusitis may be a useful strategy to decrease antibiotic use and increase patient satisfaction without compromising patient recovery."

This study suggests that point of care C-reactive protein testing may be useful in reducing antibiotic usage for rhinosinusitis and LRTI when combined with delayed prescribing.

For the full abstract, click here.

Annals of Family Medicine 8(2:124-133, March 2010 © 2010 Annals of Family Medicine, Inc.
Point-of-Care C-Reactive Protein Testing and Antibiotic Prescribing for Respiratory Tract Infections: A Randomized Controlled Trial. Jochen W. L. Cals, Marjolein J. C. Schot, Sanne A. M. de Jong, Geert-Jan Dinant, and Rogier M. Hopstaken. Correspondence to Jochen Cals: [email protected]

Category: R. Respiratory. Keywords: CRP, C-reactive protein, LRTI, rhinosinusitis, antibiotics, randomized controlled trial, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 18 May 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.