title: The role of appropriate diagnostic testing in acute respiratory tract infections: An antibiotic stewardship strategy to minimise diagnostic uncertainty in primary care.
abstract: Antibiotic resistance has increased worldwide to the extent that it is now regarded as a global public health crisis. Interventions to reduce excessive antibiotic prescribing to patients can reduce resistance and improve microbiological and clinical outcomes. Therefore, although improving outpatient antibiotic use is crucial, few data are provided on the key interventional components and the effectiveness of antibiotic stewardship in the primary care setting, in South Africa. The reasons driving the excessive prescription of antibiotics in the community are multifactorial but, perhaps most importantly, the overlapping clinical features of viral and bacterial infections dramatically reduce the ability of GPs to distinguish which patients would benefit from an antibiotic or not. As a consequence, the need for tools to reduce diagnostic uncertainty is critical. In this regard, besides clinical algorithms, a consensus of collaborators in European and UK consortia recently provided guidance for the use of C-reactive protein point-of-care testing in outpatients presenting with acute respiratory tract infections (ARTIs) and/or acute cough, if it is not clear after proper clinical assessment whether antibiotics should be prescribed or not. A targeted application of stewardship principles, including diagnostic stewardship as described in this review, to the ambulatory setting has the potential to affect the most common indications for systemic antibiotic use, in that the majority (80%) of antibiotic use occurs in the community, with ARTIs the most common indication.
authors.affiliation: Ampath National Laboratory Services, Milpark Hospital, Johannesburg, South Africa. brinka@ampath.co.za.
authors.forename: Adrian John
authors.initials: AJ
authors.lastname: Brink
authors.forename: Johan
authors.initials: J
authors.lastname: Van Wyk
authors.forename: V M
authors.initials: VM
authors.lastname: Moodley
authors.forename: Craig
authors.initials: C
authors.lastname: Corcoran
authors.forename: Pieter
authors.initials: P
authors.lastname: Ekermans
authors.forename: Louise
authors.initials: L
authors.lastname: Nutt
authors.forename: Tom
authors.initials: T
authors.lastname: Boyles
authors.forename: Olga
authors.initials: O
authors.lastname: Perovic
authors.forename: Charles
authors.initials: C
authors.lastname: Feldman
authors.forename: Guy
authors.initials: G
authors.lastname: Richards
authors.forename: Marc
authors.initials: M
authors.lastname: Mendelson
mesh_terms: D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D000066491:Clinical Decision-Making; D004352:Drug Resistance, Microbial; D006801:Humans; D011320:Primary Health Care; D012141:Respiratory Tract Infections / Q000175:diagnosis* / Q000188:drug therapy; D013019:South Africa; D014777:Virus Diseases / Q000175:diagnosis / Q000188:drug therapy
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; D002097:C-Reactive Protein