Antibiotic selection patterns in acutely febrile new outpatients with or without immediate testing for C reactive protein and leucocyte count.
BACKGROUND
Excessive use of broad spectrum antibiotics is related to the spread of drug resistant bacterial strains in the community.


OBJECTIVE
The effects of immediate testing for C reactive protein (CRP) and white blood cell count (WBC) on physicians' choices of antibiotic was investigated in patients with acute infection. Acutely febrile new outpatients were randomised into two groups: group 1 (147 patients) underwent CRP and WBC testing before initial consultation (advance testing). Prescriptions were compared with those in group 2 (no advance testing; 154 patients).


RESULTS
In non-pneumonic acute respiratory tract infections, 61 (58%) and 122 (91%) of group 1 and 2 patients were prescribed antibiotics, respectively. Cefcapene pivoxil (third generation cephalosporin) and amoxicillin were the most frequently chosen drugs for group 1 and 2, respectively. Total prescriptions of newer, extended spectrum antibiotics (cefcapene pivoxil and clarithromycin (advanced macrolide)) were reduced by 25% in group 1, although they increased in rate (41 (67%) v 55 (45%) prescriptions) because of the decreased prescription of amoxicillin. In group 1, cefcapene pivoxil was preferentially selected when WBC values were greater than 9 x 10(9)/litre. Prescription shifted to macrolides (mainly clarithromycin) in patients without leucocytosis. Patient treatment outcome did not significantly differ between the two groups.


CONCLUSIONS
The availability of CRP and WBC data during initial consultation greatly reduced prescription of amoxicillin, but had a lesser effect on newer, potent, broad spectrum antibiotics.
Department of Laboratory Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan. yutakemu@interlink.or.jp
Y
Y
Takemura
K
K
Ebisawa
H
H
Kakoi
H
H
Saitoh
H
H
Kure
H
H
Ishida
M
M
Kure
D000208:Acute Disease; D000328:Adult; D000658:Amoxicillin / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001424:Bacterial Infections / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D002511:Cephalosporins / Q000008:administration & dosage; D017291:Clarithromycin / Q000008:administration & dosage; D005334:Fever / Q000097:blood / Q000382:microbiology*; D006801:Humans; D007564:Japan; D007958:Leukocyte Count; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D010818:Practice Patterns, Physicians'; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000188:drug therapy; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D015415:Biomarkers; D002511:Cephalosporins; C425944:cefcapene pivoxil hydrochloride; D000658:Amoxicillin; D002097:C-Reactive Protein; D017291:Clarithromycin