Table 1

Studies that examine antibiotic prescribing for patients presenting with symptoms of RTI to GPs who use POCT biomarkers compared with normal care

Author and datePatient groupStudy typeOutcomesKey results
Diederichsen et al 20003435 general practices, County of Funen, Denmark.
PATIENTS: 812 patients with respiratory infection
Randomised controlled trialFrequency of antibiotic prescriptions and morbidity 1 week after the consultation, as stated by the patientsThe 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 20094040 general practitioners from 20 practices in the Netherlands recruited 431 patients with lower respiratory tract infectionCluster randomised controlled trialMain outcome measures The primary outcome was antibiotic prescribing at the index consultationGeneral 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 201033258 patients were enrolled (107 LRTI and 151 rhinosinusitis) by 32 family physicians in the NetherlandsRandomised controlled trialAntibiotic prescribing rate, recovery and patient satisfactionPatients 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 201314Patients presenting with upper or lower RTI in primary-care practices in six European countriesCluster randomised trialAntibiotic prescribing rateGP 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 201430179 patients with acute cough/LRTI (including acute bronchitis, pneumonia and infectious exacerbations of COPD or asthma) from 18 Russian GP practicesOpen cluster randomised clinical trialAntibiotic prescribing rates, referral for chest X-ray and recovery rateThe 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 20135513 studies in 10 005 patients presenting to GPs with RTISystematic review and meta-analysisAssociation between point-of-care CRP testing and antibiotic prescribing in respiratory tract infectionsPOC 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 2014316 trials (3284 participants; 139 children) Patients presenting with symptoms of acute respiratory infections in primary careSystematic 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 RTIReduction 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 201146Cost-effectiveness analysis with a time horizon of 28 days in 431 patients with LRTIs recruited by 40 GPsEconomic analysis alongside a factorial, cluster randomised trialHealthcare 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 201347Patients with acute cough and LRTI in primary care settings in Norway and SwedenEconomic analysis alongside an observational studyAntibiotic 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 201548Three 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 testingEconomic analysis using decision tree and Markov modelQuality-adjusted life years (QALYs) and cost per 100 patients, together with the number of antibiotic prescriptions and RTIs for each groupCompared 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.