Abstract
PURPOSE Antibiotics are only beneficial for subgroups of patients with acute lower respiratory tract infections (LRTI) and rhinosinusitis in family practice, yet overprescribing for these conditions is common. C-reactive protein (CRP) point-of-care testing and delayed prescribing are useful strategies to reduce antibiotic prescribing, but both have limitations. We evaluated the effect of CRP assistance in antibiotic prescribing strategies—including delayed prescribing—in the management of LRTI and rhinosinusitis.
METHODS We conducted a randomized controlled trial in which 258 patients were enrolled (107 LRTI and 151 rhinosinusitis) by 32 family physicians. Patients were individually randomized to CRP assistance or routine care (control). Primary outcome was antibiotic use after the index consultation. Secondary outcomes included antibiotic use during the 28-day follow-up, patient satisfaction, and clinical recovery.
RESULTS Patients in the CRP-assisted group used fewer antibiotics (43.4%) than control patients (56.6%) after the index consultation (relative risk [RR] = 0.77; 95% confidence interval [CI], 0.56–0.98). This difference remained significant during follow-up (52.7% vs 65.1%; RR = 0.81; 95% CI, 0.62–0.99). Delayed prescriptions in the CRP-assisted group were filled only in a minority of cases (23% vs 72% in control group, P <.001). Recovery was similar across groups. Satisfaction with care was higher in patients managed with CRP assistance (P = .03).
CONCLUSIONS CRP point-of-care testing to assist in prescribing decisions, including delayed prescribing, for LRTI and rhinosinusitis may be a useful strategy to decrease antibiotic use and increase patient satisfaction without compromising patient recovery.
Annals Journal Club selection—see inside back cover or http://www.annfammed.org/AJC/.
- Received for publication April 28, 2009.
- Revision received October 2, 2009.
- Accepted for publication October 23, 2009.
- © 2010 Annals of Family Medicine, Inc.
Jump to section
Related Articles
Cited By...
- How, why and when are delayed (back-up) antibiotic prescriptions used in primary care? A realist review integrating concepts of uncertainty in healthcare
- Determinants of inappropriate antibiotic prescription in primary care in developed countries with general practitioners as gatekeepers: a systematic review and construction of a framework
- C-reactive protein cut-offs used for acute respiratory infections in Danish general practice
- Implementation of C-reactive protein point of care testing to improve antibiotic targeting in respiratory illness in Vietnamese primary care (ICAT): a study protocol for a cluster randomised controlled trial
- Liver Function in Novel Coronavirus Disease (COVID-19): A Systematic Review and Meta-Analysis
- Challenges and opportunities for antibiotic stewardship among preterm infants
- Antibiotic Prescribing for Acute Respiratory Tract Infections 12 Months After Communication and CRP Training: A Randomized Trial
- Accuracy of Signs and Symptoms for the Diagnosis of Acute Rhinosinusitis and Acute Bacterial Rhinosinusitis
- Impact of point-of-care C reactive protein in ambulatory care: a systematic review and meta-analysis
- Use of C-reactive protein to tailor antibiotic use: a systematic review and meta-analysis
- Funding and policy incentives to encourage implementation of point-of-care C-reactive protein testing for lower respiratory tract infection in NHS primary care: a mixed-methods evaluation
- C-reactive protein: guiding antibiotic prescribing decisions at the point of care
- Patient Willingness to Have Tests to Guide Antibiotic Use for Respiratory Tract Infections: From the WWAMI Region Practice and Research Network (WPRN)
- Proposed Clinical Decision Rules to Diagnose Acute Rhinosinusitis Among Adults in Primary Care
- Qualitative study of primary care clinicians views on point-of-care testing for C-reactive protein for acute respiratory tract infections in family medicine
- Point-of-care CRP testing in the diagnosis of pneumonia in adults
- Diagnosis of acute rhinosinusitis in primary care: a systematic review of test accuracy
- Narrative review of primary care point-of-care testing (POCT) and antibacterial use in respiratory tract infection (RTI)
- Clinical presentation and microbiological diagnosis in paediatric respiratory tract infection: a systematic review
- Current and future use of point-of-care tests in primary care: an international survey in Australia, Belgium, The Netherlands, the UK and the USA
- Association between point-of-care CRP testing and antibiotic prescribing in respiratory tract infections: a systematic review and meta-analysis of primary care studies
- Antibiotic prescribing and C-reactive protein testing for pulmonary infections in patients with intellectual disabilities
- Risks and Benefits Associated With Antibiotic Use for Acute Respiratory Infections: A Cohort Study
- Enhanced Communication Skills and C-reactive Protein Point-of-Care Testing for Respiratory Tract Infection: 3.5-year Follow-up of a Cluster Randomized Trial
- Interventions to reduce antibiotic prescription for lower respiratory tract infections: Happy Audit study
- Predictors of clinical outcome in a national hospitalised cohort across both waves of the influenza A/H1N1 pandemic 2009-2010 in the UK
- Why do children hospitalised with pneumonia not receive antibiotics in primary care?
- GPs' views in five European countries of interventions to promote prudent antibiotic use
- Multidisciplinary Discourse
- Tip of the Iceberg
- In This Issue: Relationships Count for Patients and Doctors Alike
- Point-of-care C-reactive protein to assist antibiotic prescribing for respiratory tract infections.