You are here

  • Home
  • Archive
  • Volume 7, Issue 1
  • Respiratory tract infections (RTIs) in primary care: narrative review of C reactive protein (CRP) point-of-care testing (POCT) and antibacterial use in patients who present with symptoms of RTI

Article Text

Article menu

Download PDFPDF

Respiratory infection
Respiratory tract infections (RTIs) in primary care: narrative review of C reactive protein (CRP) point-of-care testing (POCT) and antibacterial use in patients who present with symptoms of RTI
  1. Jonathan Cooke1,2,
  2. Carl Llor3,
  3. Rogier Hopstaken4,
  4. Matthew Dryden5 and
  5. Christopher Butler6
  1. 1Department of Surgery and Cancer, Faculty of Medicine, Imperial College, London, United Kingdom
  2. 2Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
  3. 3Primary Care, University Institute in Primary Care Research Jordi Gol, Barcelona, Spain
  4. 4Star-shl diagnostic centers, Etten-Leur, The Netherlands
  5. 5Department of Microbiology, Hampshire Hospitals NHS Foundation Trust, Winchester, UK
  6. 6The Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
  1. Correspondence to Professor Jonathan Cooke; j.cooke{at}imperial.ac.uk

Abstract

Antimicrobial resistance (AMR) continues to be a global problem and continues to be addressed through national strategies to improve diagnostics, develop new antimicrobials and promote antimicrobial stewardship. Patients who attend general (ambulatory) practice with symptoms of respiratory tract infections (RTIs) are invariably assessed by some sort of clinical decision rule (CDR). However, CDRs rely on a cluster of non-specific clinical observations. A narrative review of the literature was undertaken to ascertain the value of C reactive protein (CRP) point-of-care testing (POCT) to guide antibacterial prescribing in adult patients presenting to general practitioner (GP) practices with symptoms of RTI. Studies that were included were Cochrane reviews, systematic reviews, randomised controlled trials, cluster randomised trials, controlled before and after studies, cohort studies and economic evaluations. An overwhelming number of studies demonstrated that the use of CRP tests in patients presenting with RTI symptoms reduces index antibacterial prescribing. 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. With the rapid development of artificial intelligence, patients will expect greater precision in diagnosing and managing their illnesses. Adopting systems that markedly reduce antibiotic consumption is a no-brainer for governments that are struggling to address the rise in AMR.

  • bacterial infection
  • respiratory infection
http://creativecommons.org/licenses/by-nc/4.0/

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, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjresp-2020-000624

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • Contributors JC is the lead author and all the other coauthors have contributed to the development of this work.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests JC has chaired, presented and received honoraria at meetings supported by Astellas, Cubist,Abbott, LumiraDx and HHI. CL has received research grants from Abbott Diagnostics. CB has received advisory board fees from Roche Molecular Systems and grant support from Roche Molecular Diagnostics. RH received a grant from Alere for a study on the value of point-of-care CRP measurement in children and speaker fees from Alere for lectures on antibiotic resistance.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. Freely available.