Abstract
C-reactive protein (CRP) point-of-care testing (POCT) is increasingly being promoted to reduce diagnostic uncertainty and enhance antibiotic stewardship. In primary care, respiratory tract infections (RTIs) are the most common reason for inappropriate antibiotic prescribing, which is a major driver for antibiotic resistance. We systematically reviewed the available evidence on the impact of CRP-POCT on antibiotic prescribing for RTIs in primary care. Thirteen moderate to high-quality studies comprising 9844 participants met our inclusion criteria. Meta-analyses showed that CRP-POCT significantly reduced immediate antibiotic prescribing at the index consultation compared with usual care (RR 0.79, 95%CI 0.70 to 0.90, p = 0.0003, I2 = 76%) but not during 28-day (n = 7) follow-up. The immediate effect was sustained at 12 months (n = 1). In children, CRP-POCT reduced antibiotic prescribing when CRP (cut-off) guidance was provided (n = 2). Meta-analyses showed significantly higher rates of re-consultation within 30 days (n = 8, 1 significant). Clinical recovery, resolution of symptoms, and hospital admissions were not significantly different between CRP-POCT and usual care. CRP-POCT can reduce immediate antibiotic prescribing for RTIs in primary care (number needed to (NNT) for benefit = 8) at the expense of increased re-consultations (NNT for harm = 27). The increase in re-consultations and longer-term effects of CRP-POCT need further evaluation. Overall, the benefits of CRP-POCT outweigh the potential harms (NNTnet = 11).
Highlights
Acute respiratory tract infections (RTIs) are among the most common reasons for patient encounters in primary care and for inappropriate antibiotic prescribing, which is a major driver for antibiotic resistance (ABR) [1,2,3,4,5]
In this systematic review and meta-analysis, we comprehensively summarised the available evidence from 13 randomised controlled trials (RCTs) on the clinical effectiveness of C-reactive protein (CRP)-point-of-care testing (POCT) with usual care in reducing antibiotic prescribing for RTIs in primary care
Based on evidence of moderate to high- quality, our results demonstrate that CRP-POCT can reduce immediate antibiotic prescribing in patients presenting to primary care with upper and lower RTIs
Summary
Acute respiratory tract infections (RTIs) are among the most common reasons for patient encounters in primary care and for inappropriate antibiotic prescribing, which is a major driver for antibiotic resistance (ABR) [1,2,3,4,5]. The vast majority of patients with these infections, receive an antibiotic prescription for systemic use after seeking medical attention from their primary care physician [4,10]. The rates of antibiotic prescribing have been directly associated with the rates of ABR at the individual, community, and national levels [3,4]. The reduction of antibiotic prescribing for acute RTIs could help to decrease ABR. If no effective actions are taken ABR could become the leading cause of death, surpassing cancer [16]
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