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GP point-of-care testing 'effectively reduces antibiotic prescribing in children'

Access to point of care CRP testing makes GPs less likely to prescribe antibiotics to children with non-severe infections, a study has found.

Normal CRP levels may reassure GPs that they don’t need to prescribe when clinical guidelines leave room for doubt, the study authors suggested.

The study, carried out by researchers in Belgium, looked at just under 3,000 children under the age of 16 who presented to their GP with a non-severe acute infection. Around 1,700 children were given a point of care CRP test, the results for which were available within four minutes, and half were not.

They found that when CRP levels were tested and found to be normal, GPs were almost 50% less likely to prescribe antibiotics than in children who didn’t have the test, even when guidelines based on clinical signs suggested that antibiotics could be prescribed.

They also found that elevated CRP levels did not lead to significantly increased levels of prescribing, apart from in cases where clinical signs didn’t point to a clear diagnosis.

All children in the study recovered from their infections and there were no hospitalisations attributed to under-prescribing.

The paper said: ‘Evidence based medicine guidelines are vague at some points. Probably, normal CRP levels tipped the scale to withhold antibiotics in illness episodes in which the practice guideline advice leaves too much room for doubt.

‘We hypothesize that a normal CRP offered GPs a convincing argument to withhold antibiotic in those illness episodes where advice to prescribe antibiotics went against their own gut feeling.’

NHS England announced the launch of a new scheme earlier this year, which would see point of care CRP testing introduced in to GP surgeries in order to reduce inappropriate antibiotic prescribing. rticle

The House of Commons Health and Social Care Committee said in a report on antimicrobial resistance in October, however, that many GPs were not using point of care testing due to high costs that were not absorbed by the CCGs.

The report said that action needed to be taken to address ‘peverse financial’ barriers to the roll out of CRP testing in GP practices. 

Readers' comments (5)

  • Just Your Average Joe

    Should be provided and distributed free for use in GP surgeries as its use would be offset by savings in prescribing budgets.

    Not free, forget implementation.

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  • David Banner

    CRP is neither specific nor sensitive enough to warrant routine use.

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  • Takes ages- take test out of fridge- wait 10 minutes.... use and re see patient???
    Madness- when a single session is a chaotic 7 hour marathon- I don’t have time for this! I still use clinical acumen thanks!

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  • doctordog.

    Interesting way of reducing attendance of children.

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  • The study was in Belgium, which has a relatively high antibiotic prescribing rate compared to other countries [Ref](https://www.tandfonline.com/doi/full/10.1080/02813432.2017.1288680)

    It might not work here were we are starting from a somewhat different baseline.

    Belgian GPs are also paid fee for service, patients don't register with a practice and can consult any GP.[Ref](https://www.mja.com.au/system/files/issues/181_02_190704/van10171_fm.pdf) So really quite a different system.

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