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Point-of-care CRP tests ‘can reduce unnecessary antibiotic prescriptions’

On-the-spot C-reactive protein tests can reduce antibiotic use for acute respiratory infections, a Cochrane systematic review has concluded.

The point-of-care test – which helps differentiate between a viral and a bacterial infection – reduced antibiotic use in general practice without impacting on the time to recovery from acute respiratory infections or patient satisfaction – although the study authors caution they could not rule out a possible increase in risk of hospital admission with use of the tests.

The researchers looked at evidence from randomised trials on use of the C-reactive protein (CRP) test – currently the only on-the-spot kit available to GPsto guide antibiotic prescription. The CRP test involves testing a single drop of blood – collected by pricking the patient’s finger. The test takes approximately three minutes to run, with low levels of CRP potentially ruling out a serious infection, avoiding the need for antibiotic prescription.

Data on the use of the on-the-spot tests from six trials were included, including 3,284 patients, mainly adults. Of the 1,685 patients who had the test performed, 631 were prescribed antibiotics, compared with 785 out of the 1,599 people who did not take the test.

This meant antibiotic use was 22% lower overall in the patients who underwent CRP testing than those who did not – although results varied considerably between studies.    

There was no difference in clinical recovery – substantial improvement by day 7 or 28 or need for reconsultation at day 28 – between the two groups, and no deaths were reported in any of the studies.

There was an increase in hospitalisations in the CRP test group in one study, but the authors said ‘this was based on a few events and may be a chance finding’.

NICE has been consulting on whether to recommend GPs use point-of-care CRP tests to help guide antibiotic use for mild pneumonia.

Lead researcher Dr Rune Aabenhus, from the University of Copenhagen, said: ‘These results suggest that antibiotic use in patients with acute respiratory infections could be reduced by carrying out biomarker tests in addition to routine examinations.

‘Going forward, it would be useful to see more evidence on the size of the reduction and cost-savings, as well as how these tests compare to other antibiotic-saving approaches.’

Cochrane Database of Systematic Reviews 2014; available online 6 November

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