Studies that examine antibiotic prescribing for patients presenting with symptoms of RTI to GPs who use POCT biomarkers compared with normal care
| Author and date | Patient group | Study type | Outcomes | Key results |
|---|---|---|---|---|
| Diederichsen et al 200034 | 35 general practices, County of Funen, Denmark. PATIENTS: 812 patients with respiratory infection | Randomised controlled trial | Frequency of antibiotic prescriptions and morbidity 1 week after the consultation, as stated by the patients | The frequency of antibiotic prescriptions was 43% (179/414) in a CRP group compared with 46% (184/398) in the control group (OR=0.9, NS) |
| Cals et al 200940 | 40 general practitioners from 20 practices in the Netherlands recruited 431 patients with lower respiratory tract infection | Cluster randomised controlled trial | Main outcome measures The primary outcome was antibiotic prescribing at the index consultation | General practitioners in a CRP test group prescribed antibiotics to 31% of patients compared with 53% in the no test group (42% lower p=0.02). Patients’ recovery and satisfaction were similar in both study groups |
| Cals et al 201033 | 258 patients were enrolled (107 LRTI and 151 rhinosinusitis) by 32 family physicians in the Netherlands | Randomised controlled trial | Antibiotic prescribing rate, recovery and patient satisfaction | Patients in a CRP-assisted group were prescribed fewer antibiotics (43.4%) than control patients (56.6%; 23.5% lower) after the index consultation (relative risk (RR)=0.77; 95% CI 0.56 to 0.98). Recovery was similar across groups. Satisfaction with care was higher in patients managed with CRP assistance (p=0.03) |
| Little et al 201314 | Patients presenting with upper or lower RTI in primary-care practices in six European countries | Cluster randomised trial | Antibiotic prescribing rate | GP antibiotic prescribing was lower with CRP training than without (33% vs 48%—31% lower, adjusted risk ratio 0.54, 95% CI 0.42 to 0.69) and with enhanced-communication training than without (36% vs 45%, 0.69, 0.54–0.87). The combined intervention was associated with the greatest reduction in prescribing rate (CRP risk ratio 0.53, 95% CI 0.36 to 0.74, p<0.0001; enhanced communication 0.68, 0.50–0.89, p=0.003; combined 0.38, 0.25–0.55, p<0.0001) |
| Andreeva and Melbye 201430 | 179 patients with acute cough/LRTI (including acute bronchitis, pneumonia and infectious exacerbations of COPD or asthma) from 18 Russian GP practices | Open cluster randomised clinical trial | Antibiotic prescribing rates, referral for chest X-ray and recovery rate | The antibiotic prescribing rate was 37.6% in the CRP group, which was significantly lower than that in the control group (58.9%; p=0.006). Referral for chest X-ray was also significantly lower in the intervention group (55.4%) than in the control group (75.6%) (p=0.004). The recovery rate, as recorded by the GPs, was 92.9% and 93.6% in the intervention and control groups, respectively |
| Systematic reviews | ||||
| Huang et al 201355 | 13 studies in 10 005 patients presenting to GPs with RTI | Systematic review and meta-analysis | Association between point-of-care CRP testing and antibiotic prescribing in respiratory tract infections | POC CRP testing was associated with a significant reduction in antibiotic prescribing at the index consultation (RR 0.75, 95% CI 0.67 to 0.83) |
| Aabenhus et al 201431 | 6 trials (3284 participants; 139 children) Patients presenting with symptoms of acute respiratory infections in primary care | Systematic review (Cochrane Review) | To assess the benefits and harms of point-of-care biomarker tests of infection to guide antibiotic treatment in patients in primary care presenting with symptoms of RTI | Reduction in the use of antibiotic treatments was found in studies comparing C reactive protein (631/1685) with standard of care (785/1599) |
| Economic evaluations | ||||
| Cals et al 201146 | Cost-effectiveness analysis with a time horizon of 28 days in 431 patients with LRTIs recruited by 40 GPs | Economic analysis alongside a factorial, cluster randomised trial | Healthcare costs. Cost-effectiveness, using the primary outcome measure antibiotic prescribing at index consultation, was assessed by incremental cost-effectiveness ratios (ICER) | The total mean cost per patient in the usual care group was €35.96 with antibiotic prescribing of 68%, €37.58 per patient managed by GPs using CRP tests (antibiotic prescribing 39%, ICER €5.79), €25.61 per patient managed by GPs trained in enhanced communication skills (antibiotic prescribing 33%, dominant) and €37.78 per patient managed by GPs using both interventions (antibiotic prescribing 23%, ICER €4.15) |
| Oppong 201347 | Patients with acute cough and LRTI in primary care settings in Norway and Sweden | Economic analysis alongside an observational study | Antibiotic use, cost, and patient outcomes (symptom severity after 7 and 14 days, time to recovery, and EQ-5D) | POCCRP testing was associated with a cost per quality-adjusted life year (QALY) gain of €9391. At a willingness-to-pay threshold of €30 000 per QALY gained, there is a 70% probability of CRP being cost-effective |
| Hunter 201548 | Three different strategies of CRP testing (GP plus CRP; practice nurse plus CRP; and GP plus CRP and communication training) for patients with RTI symptoms compared with current standard GP practice without CRP testing | Economic analysis using decision tree and Markov model | Quality-adjusted life years (QALYs) and cost per 100 patients, together with the number of antibiotic prescriptions and RTIs for each group | Compared with current standard practice, the GP plus CRP and practice nurse plus CRP test strategies result in increased QALYs and reduced costs, while the GP plus CRP testing and communication training strategy is associated with increased costs and reduced QALYs. Additionally, all three CRP arms led to fewer antibiotic prescriptions and infections over 3 years |
CRP, C reactive protein; COPD, chronic obstructive pulmonary disease; LRTI, lower respiratory tract infection; RTI, respiratory tract infection.