Point-of-care C-reactive protein testing and antibiotic prescribing for respiratory tract infections: a randomized controlled trial.
OBJECTIVE
Antibiotics are only beneficial for subgroups of patients with acute lower respiratory tract infections (LRTI) and rhinosinusitis in family practice, yet overprescribing for these conditions is common. C-reactive protein (CRP) point-of-care testing and delayed prescribing are useful strategies to reduce antibiotic prescribing, but both have limitations. We evaluated the effect of CRP assistance in antibiotic prescribing strategies-including delayed prescribing-in the management of LRTI and rhinosinusitis.


METHODS
We conducted a randomized controlled trial in which 258 patients were enrolled (107 LRTI and 151 rhinosinusitis) by 32 family physicians. Patients were individually randomized to CRP assistance or routine care (control). Primary outcome was antibiotic use after the index consultation. Secondary outcomes included antibiotic use during the 28-day follow-up, patient satisfaction, and clinical recovery.


RESULTS
Patients in the CRP-assisted group used fewer antibiotics (43.4%) than control patients (56.6%) after the index consultation (relative risk [RR] = 0.77; 95% confidence interval [CI], 0.56-0.98). This difference remained significant during follow-up (52.7% vs 65.1%; RR = 0.81; 95% CI, 0.62-0.99). Delayed prescriptions in the CRP-assisted group were filled only in a minority of cases (23% vs 72% in control group, P < .001). Recovery was similar across groups. Satisfaction with care was higher in patients managed with CRP assistance (P = .03).


CONCLUSIONS
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.
Cals
Jochen W L
JW
Department of General Practice, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre, Maastricht, The Netherlands. j.cals@hag.unimaas.nl
Schot
Marjolein J C
MJ
de Jong
Sanne A M
SA
Dinant
Geert-Jan
GJ
Hopstaken
Rogier M
RM
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002097:C-Reactive Protein; D004363:Drug Utilization; D005260:Female; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017060:Patient Satisfaction; D010821:Physicians, Family; D019095:Point-of-Care Systems; D010818:Practice Patterns, Physicians'; D012141:Respiratory Tract Infections / Q000175:diagnosis* / Q000188:drug therapy*; D012220:Rhinitis / Q000175:diagnosis / Q000188:drug therapy; D012852:Sinusitis / Q000175:diagnosis / Q000188:drug therapy; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein