Point-of-care C-reactive protein testing and antibiotic prescribing for respiratory tract infections: a randomized controlled trial

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.

Figure 1.

Trial profile.

Figure 2.

Median symptom scores per group during first week after index consultation. CRP = C-reactive protein; LTRI = lower respiratory tract infection. Symptom scores for LRTI were calculated by summing and deriving percentage total scores for 6 symptoms: cough, phlegm, sleeping problems, dyspnea, degree of illness, and limitations in daily activities. Symptom scores for rhinosinusitis were calculated by summing and deriving percentage total scores for 7 symptoms: rhinorrhea, blocked nose, dental pain, headache, pain at bending over, degree of illness, and limitations in daily activities. Median symptom scores of intervention and control groups were not signifi cantly different at any day in week 1, nor when analyzed using area under the curve.