title: Narrative review of primary care point-of-care testing (POCT) and antibacterial use in respiratory tract infection (RTI).
abstract: Antimicrobial resistance is a global problem and is being addressed through national strategies to improve diagnostics, develop new antimicrobials and promote antimicrobial stewardship. A narrative review of the literature was undertaken to ascertain the value of C reactive protein (CRP) and procalcitonin, measurements to guide antibacterial prescribing in adult patients presenting to GP practices with symptoms of respiratory tract infection (RTI). Studies that were included were randomised controlled trials, controlled before and after studies, cohort studies and economic evaluations. Many studies demonstrated that the use of CRP tests in patients presenting with RTI symptoms reduces antibiotic prescribing by 23.3% to 36.16%. Procalcitonin is not currently available as a point-of-care testing (POCT), but has shown value for patients with RTI admitted to hospital. GPs and patients report a good acceptability for a CRP POCT and economic evaluations show cost-effectiveness of CRP POCT over existing RTI management in primary care. POCTs increase diagnostic precision for GPs in the better management of patients with RTI. CRP POCT can better target antibacterial prescribing by GPs and contribute to national antimicrobial resistance strategies. Health services need to develop ways to ensure funding is transferred in order for POCT to be implemented.
authors.affiliation: Division of Infectious Diseases, Department of Medicine , The Centre for Infection Prevention and Management, Imperial College London , London , UK ; Faculty of Medical and Human Sciences , University of Manchester , Manchester , UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Cooke
authors.affiliation: Nuffield Department of Primary Care Health Sciences , University of Oxford , Oxford , UK ; Cochrane Institute of Primary Care & Public Health, School of Medicine, Cardiff University , Cardiff , UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Butler
authors.affiliation: Saltro Diagnostic Centre for Primary Care , Utrecht , T he Netherlands.
authors.forename: Rogier
authors.initials: R
authors.lastname: Hopstaken
authors.affiliation: Department of Microbiology , Hampshire Hospitals NHS Foundation Trust , Winchester , UK.
authors.forename: Matthew Scott
authors.initials: MS
authors.lastname: Dryden
authors.affiliation: Public Health England, Primary Care Unit, Microbiology Department , Gloucestershire Royal Hospital , Gloucester , UK.
authors.forename: Cliodna
authors.initials: C
authors.lastname: McNulty
authors.affiliation: Scottish Government , Clinical Lead Therapeutics Branch , Edinburgh , UK ; Medicines Management Adviser NHS Lothian , Edinburgh , UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Hurding
authors.affiliation: Primary Care and Population Sciences , University of Southampton Aldermoor Health Centre , Aldermoor Close , UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Moore
authors.affiliation: Norwich Medical School, University of East Anglia , Norwich , UK ; Antimicrobial Resistance & Healthcare Associated Infections Reference Unit , Public Health England , London , UK.
authors.forename: David Martin
authors.initials: DM
authors.lastname: Livermore
keywords: Bacterial Infection; Pneumonia; Respiratory Infection