Table 2

Criteria for management of RTIs in general practice with CRP POCT after proper clinical examination of the patient

ManagementDraft NICE guidance for Pneumonia49Dutch GP practice guideline54GRACE study14ERS51
Self-limiting RTI.
Do not routinely offer antibiotic therapy.
Pneumonia unlikely.
Give education
CRP less than 20 mg/LCRP less than 20 mg/LCRP less than 20 mg/LCRP less than 20 mg/L
Majority of patients have self-limiting LRTI.
Assessment of signs, symptoms, risk factors and CRP is important.
Withhold antibiotics, in most cases
CRP 21–50 mg/L
Assessment of signs, symptoms, risk factors and CRP is crucial.
Withhold antibiotics in the majority of cases and consider delayed antibiotics in the minority of cases
CRP 51–99 mg/L
Consider a delayed antibiotic prescription.
Clinical presentation decisive.
Prescribe antibiotics only in patients with a high risk of complications*
CRP between
20 and 100 mg/L
CRP between
20 and 100 mg/L
Severe infection.
High risk of pneumonia.
Offer antibiotic therapy
CRP greater than 100 mg/LCRP greater than 100 mg/LCRP greater than 100 mg/LCRP greater than 100 mg/L
  • *Complicated respiratory tract infection.

  • A complicated respiratory tract infection is an infection with an increased risk of a complicated course (mortality or hospital admission). Two groups are distinguished.

    1. Patients with a probable diagnosis of pneumonia based on:

      • ▸ Acute cough AND:

        • – Being severely ill, with for example, tachypnoea, tachycardia, hypotension (systolic blood pressure <90, diastolic blood pressure <60 mm Hg) or confusion;

        • – Being moderately ill and unilateral auscultatory abnormalities (however, the absence of auscultatory abnormalities does not rule out pneumonia);

        • – An infiltrate on chest X-ray;

        • – A course >7 days with fever and cough (without abnormalities on physical examination).

        • – For values between 20 and 100 mg/L, the clinical presentation determines policy, along with risk factors such as heart failure, diabetes mellitus, COPD, asthma, age <3 months or >75 years;

    2. Patients with another risk factor for a complicated course.

      • ▸ Other risk factors—particularly age and comorbidities—should also be included in the evaluation of patients with acute cough. The following factors increase risk of hospital admission and mortality:

        • – Age <3 months or >75 years;

        • – In children, cardiovascular and pulmonary conditions (except asthma);

        • – In adults: heart failure, severe COPD, diabetes mellitus (esp. with use of insulin), neurological conditions, severe renal insufficiency;

        • – A disrupted immune system (owing to oncological conditions, renal insufficiency).54

  • CRP, C reactive protein; COPD, chronic obstructive pulmonary disease; POCT, point-of care-test; RTI, respiratory tract infection; NICE, National Institute for Health and Care Excellence.