title: Association between point-of-care CRP testing and antibiotic prescribing in respiratory tract infections: a systematic review and meta-analysis of primary care studies.
abstract: BACKGROUND
  Most patients with respiratory tract infections (RTIs) are prescribed antibiotics in general practice. However, there is little evidence that antibiotics bring any value to the treatment of most RTIs. Point-of-care C-reactive protein testing may reduce antibiotic prescribing.
  
  
  OBJECTIVE
  To systematically review studies that have examined the association between point-of-care (POC) C-reactive protein testing and antibiotic prescribing for RTIs in general practice.
  
  
  METHODS
  Systematic review and meta-analysis of randomised controlled trials and observational studies.
  
  
  METHODS
  MEDLINE(®) and Embase were systematically searched to identify relevant publications. All studies that examined the association between POC C-reactive protein testing and antibiotic prescribing for patients with RTIs were included. Two authors independently screened the search results and extracted data from eligible studies. Dichotomous measures of outcomes were combined using risk ratios (RRs) with 95% confidence intervals (CIs) either by fixed or random-effect models.
  
  
  RESULTS
  Thirteen studies containing 10 005 patients met the inclusion criteria. POC C-reactive protein testing was associated with a significant reduction in antibiotic prescribing at the index consultation (RR 0.75, 95% CI = 0.67 to 0.83), but was not associated with antibiotic prescribing at any time during the 28-day follow-up period (RR 0.85, 95% CI = 0.70 to 1.01) or with patient satisfaction (RR 1.07, 95% CI = 0.98 to 1.17).
  
  
  CONCLUSIONS
  POC C-reactive protein testing significantly reduced antibiotic prescribing at the index consultation for patients with RTIs. Further studies are needed to analyse the confounders that lead to the heterogeneity.
authors.affiliation: School of General Practice and Continuing Education, Capital Medical University, Beijing, China.
authors.forename: Yafang
authors.initials: Y
authors.lastname: Huang
authors.forename: Rui
authors.initials: R
authors.lastname: Chen
authors.forename: Tao
authors.initials: T
authors.lastname: Wu
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Wei
authors.forename: Aimin
authors.initials: A
authors.lastname: Guo
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D058006:General Practice / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D064887:Observational Studies as Topic; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D019095:Point-of-Care Systems; D010818:Practice Patterns, Physicians'; D016032:Randomized Controlled Trials as Topic; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000188:drug therapy*; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein