Point-of-care C-reactive protein to assist in primary care management of children with suspected non-serious lower respiratory tract infection: a randomised controlled trial.

Marjolein Jc Schot,Niek J De Wit,Jochen Wl Cals,Eveline A Noteboom,Walter Balemans,Rogier M Hopstaken,Berna Dl Broekhuizen,Sanne Van Delft,Theo Jm Verheij,Ann Van Den Bruel

doi:10.3399/bjgpopen18x101600

Abstract

BackgroundOverprescription of antibiotics for lower respiratory tract infections (LRTIs) in children is common, partly due to diagnostic uncertainty, in which case the addition of point-of-care (POC) C-reactive protein (CRP) testing can be of aid.AimTo assess whether use of POC CRP by the GP reduces antibiotic prescriptions in children with suspected non-serious LRTI.Design & settingAn open, pragmatic, randomised controlled trial in daytime general practice and out-of-hours services.MethodChildren between 3 months and 12 years of age with acute cough and fever were included and randomised to either use of POC CRP or usual care. Antibiotic prescription rates were measured and compared between groups using generalising estimating equations.ResultsThere was no statistically significant reduction in antibiotic prescriptions in the GP use of CRP group (30.9% versus 39.4%; odds ratio [OR] 0.6; 95% confidence interval [CI] = 0.29 to 1.23). Only the estimated severity of illness was related to antibiotic prescription. Forty-six per cent of children had POC CRP levels <10mg/L.ConclusionIt is still uncertain whether POC CRP measurement in children with non-serious respiratory tract infection presenting to general practice can reduce the prescription of antibiotics. Until new research provides further evidence, POC CRP measurement in these children is not recommended.

Highlights

Acute respiratory tract infections are the most common diagnoses in children in primary care.[1,2] Childhood lower respiratory tract infections (LRTIs) include acute bronchitis, bronchiolitis, and pneumonia
Forty-six per cent of children had POC C-reactive protein (CRP) levels
Until new research provides further evidence, POC CRP measurement in these children is not recommended

Summary

Introduction

Acute respiratory tract infections are the most common diagnoses in children in primary care.[1,2] Childhood LRTIs include acute bronchitis, bronchiolitis, and pneumonia. Diagnostic uncertainty, parental worries and expectations, or the GP’s anticipation of these, are important drivers of antibiotic prescriptions.[8,10,11] Even in a low prescribing country like the Netherlands, 48–63% of antibiotic prescriptions are thought to be inappropriate.[10,12] This is harmful as antibiotics cause side effects,[12] increase re-consultation rates,[13] and contribute to antimicrobial resistance. Overprescription of antibiotics for lower respiratory tract infections (LRTIs) in children is common, partly due to diagnostic uncertainty, in which case the addition of point-of-care (POC) C-reactive protein (CRP) testing can be of aid

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Conclusion