Narrative review of primary care point-of-care testing (POCT) and antibacterial use in respiratory tract infection (RTI)

Abstract

Antimicrobial resistance is a global problem and is being addressed through national strategies to improve diagnostics, develop new antimicrobials and promote antimicrobial stewardship. A narrative review of the literature was undertaken to ascertain the value of C reactive protein (CRP) and procalcitonin, measurements to guide antibacterial prescribing in adult patients presenting to GP practices with symptoms of respiratory tract infection (RTI). Studies that were included were randomised controlled trials, controlled before and after studies, cohort studies and economic evaluations. Many studies demonstrated that the use of CRP tests in patients presenting with RTI symptoms reduces antibiotic prescribing by 23.3% to 36.16%. Procalcitonin is not currently available as a point-of-care testing (POCT), but has shown value for patients with RTI admitted to hospital. GPs and patients report a good acceptability for a CRP POCT and economic evaluations show cost-effectiveness of CRP POCT over existing RTI management in primary care. POCTs increase diagnostic precision for GPs in the better management of patients with RTI. CRP POCT can better target antibacterial prescribing by GPs and contribute to national antimicrobial resistance strategies. Health services need to develop ways to ensure funding is transferred in order for POCT to be implemented.

Keywords: Bacterial Infection; Pneumonia; Respiratory Infection.

Figure 1

Forest plots for randomised and cluster randomised controlled trials from Cochrane review Biomarkers as point-of-care tests to guide prescription of antibiotics in patients with acute respiratory infections in primary care.

Figure 2

Consumption of antibacterials for systemic use (ATC group J01) at anatomical therapeutic chemical (ATC) group level 3 in the community, European Union/European Economic Area countries, 2012, expressed as defined daily dose (DDD) per 1000 inhabitants and per day. From European Centre for Disease Prevention and Control.