title: C-reactive protein testing in patients with acute rhinosinusitis leads to a reduction in antibiotic use.
abstract: OBJECTIVE
  To evaluate the effect of C-reactive protein (CRP) testing on the antibiotic prescribing in patients with acute rhinosinusitis.
  
  
  METHODS
  Audit-based study carried out in primary care centres in Spain. GPs registered episodes of rhinosinusitis during 3-week period before and after an intervention. Two types of intervention were considered: full intervention group (FIG) consisting in individual feedback based on results from the first registry, courses in rational antibiotic prescribing, guidelines, patient information leaflets, workshops on rapid tests and use of the CRP test. GPs in the partial intervention group (PIG) underwent all the above intervention except for the workshop and they did not have access to CRP. Multilevel logistic regression analysis was performed considering the prescription of antibiotics as the dependent variable.
  
  
  RESULTS
  Two hundred and ten physicians were assigned to FIG and 71 to PIG. In 2009, 59 new physicians were included as a control group. Two hundred and sixty-seven GPs visited contacts with rhinosinusitis (78.5%) registering a total of 836 cases. In the group of GPs with access to CRP rapid test, 207 patients with rhinosinusitis (75.3%) were tested and antibiotics were prescribed in 156 patients (56.7%). Antibiotics were prescribed in 87 patients (82.9%) in the group of GPs exposed to PIG and in 52 patients (86.7%) in the control group (P < 0.001). Antibiotic prescription was significantly reduced after the intervention among physicians assigned to FIG, with an odds ratio of antibiotic prescribing of 0.12 (95% confidence interval: 0.01-0.32).
  
  
  CONCLUSIONS
  Physicians with access to CRP tests significantly reduced antibiotic prescription in patients with rhinosinusitis.
authors.affiliation: Primary Healthcare Centre Jaume I, University Rovira i Virgili, Tarragona, Spain. carles.llor@urv.cat
authors.forename: Carl
authors.initials: C
authors.lastname: Llor
authors.forename: Lars
authors.initials: L
authors.lastname: Bjerrum
authors.forename: Javier
authors.initials: J
authors.lastname: Arranz
authors.forename: Guillermo
authors.initials: G
authors.lastname: García
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Cots
authors.forename: Beatriz
authors.initials: B
authors.lastname: González López-Valcárcel
authors.forename: María José
authors.initials: MJ
authors.lastname: Monedero
authors.forename: Manuel
authors.initials: M
authors.lastname: Gómez
authors.forename: Jesús
authors.initials: J
authors.lastname: Ortega
authors.forename: Gloria
authors.initials: G
authors.lastname: Guerra
authors.forename: Marina
authors.initials: M
authors.lastname: Cid
authors.forename: José
authors.initials: J
authors.lastname: Paredes
authors.forename: Vicenta
authors.initials: V
authors.lastname: Pineda
authors.forename: Carolina
authors.initials: C
authors.lastname: Pérez
authors.forename: Juan de Dios
authors.initials: Jde D
authors.lastname: Alcántara
authors.forename: Silvia
authors.initials: S
authors.lastname: Hernández
mesh_terms: D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000032:analysis*; D016001:Confidence Intervals; D003657:Decision Making; D003955:Diagnostic Tests, Routine; D005260:Female; D058006:General Practice; D006801:Humans; D016015:Logistic Models; D008297:Male; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D012220:Rhinitis / Q000188:drug therapy* / Q000503:physiopathology; D012852:Sinusitis / Q000188:drug therapy* / Q000503:physiopathology; D013030:Spain
chemical_list: D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein