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Respiratory infection
Narrative review of primary care point-of-care testing (POCT) and antibacterial use in respiratory tract infection (RTI)
  1. Jonathan Cooke1,2,
  2. Christopher Butler3,4,
  3. Rogier Hopstaken5,
  4. Matthew Scott Dryden6,
  5. Cliodna McNulty7,
  6. Simon Hurding8,9,
  7. Michael Moore10 and
  8. David Martin Livermore11,12
  1. 1Division of Infectious Diseases, Department of Medicine, The Centre for Infection Prevention and Management, Imperial College London, London, UK
  2. 2Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
  3. 3Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  4. 4Cochrane Institute of Primary Care & Public Health, School of Medicine, Cardiff University, Cardiff, UK
  5. 5Saltro Diagnostic Centre for Primary Care, Utrecht, The Netherlands
  6. 6Department of Microbiology, Hampshire Hospitals NHS Foundation Trust, Winchester, UK
  7. 7Public Health England, Primary Care Unit, Microbiology Department, Gloucestershire Royal Hospital, Gloucester, UK
  8. 8Scottish Government, Clinical Lead Therapeutics Branch, Edinburgh, UK
  9. 9Medicines Management Adviser NHS Lothian, Edinburgh, UK
  10. 10Primary Care and Population Sciences, University of Southampton Aldermoor Health Centre, Aldermoor Close, UK
  11. 11Norwich Medical School, University of East Anglia, Norwich, UK
  12. 12Antimicrobial Resistance & Healthcare Associated Infections Reference Unit, Public Health England, London, UK
  1. Correspondence to Jonathan Cooke; j.cooke{at}imperial.ac.uk

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.

  • Respiratory Infection
  • Bacterial Infection
  • Pneumonia

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjresp-2015-000086

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