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Meta-Analysis
. 2013 Nov;63(616):e787-94.
doi: 10.3399/bjgp13X674477.

Association between point-of-care CRP testing and antibiotic prescribing in respiratory tract infections: a systematic review and meta-analysis of primary care studies

Yafang Huang  1 , Rui Chen, Tao Wu, Xiaoming Wei, Aimin Guo
Affiliations
Meta-Analysis

Association between point-of-care CRP testing and antibiotic prescribing in respiratory tract infections: a systematic review and meta-analysis of primary care studies

Yafang Huang et al. Br J Gen Pract. 2013 Nov.

Abstract

Background: Most patients with respiratory tract infections (RTIs) are prescribed antibiotics in general practice. However, there is little evidence that antibiotics bring any value to the treatment of most RTIs. Point-of-care C-reactive protein testing may reduce antibiotic prescribing.

Aim: To systematically review studies that have examined the association between point-of-care (POC) C-reactive protein testing and antibiotic prescribing for RTIs in general practice.

Design and setting: Systematic review and meta-analysis of randomised controlled trials and observational studies.

Method: MEDLINE(®) and Embase were systematically searched to identify relevant publications. All studies that examined the association between POC C-reactive protein testing and antibiotic prescribing for patients with RTIs were included. Two authors independently screened the search results and extracted data from eligible studies. Dichotomous measures of outcomes were combined using risk ratios (RRs) with 95% confidence intervals (CIs) either by fixed or random-effect models.

Results: Thirteen studies containing 10 005 patients met the inclusion criteria. POC C-reactive protein testing was associated with a significant reduction in antibiotic prescribing at the index consultation (RR 0.75, 95% CI = 0.67 to 0.83), but was not associated with antibiotic prescribing at any time during the 28-day follow-up period (RR 0.85, 95% CI = 0.70 to 1.01) or with patient satisfaction (RR 1.07, 95% CI = 0.98 to 1.17).

Conclusion: POC C-reactive protein testing significantly reduced antibiotic prescribing at the index consultation for patients with RTIs. Further studies are needed to analyse the confounders that lead to the heterogeneity.

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Figures

Figure 1
Figure 1
Flow chart of study selection.
Figure 2
Figure 2
Antibiotic prescribing at the index consultation. IV = inverse variance.
Figure 3
Figure 3
Antibiotic prescribing at any time during the 28-day follow-up period and patient satisfaction. IV = inverse variance. Antibiotic prescribing and patient satisfaction estimated from meta-analysis of RTI patients with point-of-care CRP testing (intervention group) versus no point-of-care CRP testing (control group). (A) Antibiotic prescribing at any time during the 28-day follow-up period. (B) Patient satisfaction.
See this image and copyright information in PMC

Comment in

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