Rapid Test Decreases Antibiotic Use for Respiratory Infections

A team including researchers from Oxford University has found that using a rapid, 5-minute test to detect C-reactive protein (CRP) reduced antibiotic use for nonsevere acute respiratory tract infection and did so without compromising patients' recovery.

Noting that inappropriate antibiotic use for acute respiratory tract infections is common in primary health care, and acknowledging the difficulty of distinguishing serious from self-limiting infections, the authors conducted a multicenter, randomized, controlled trial in 10 primary health care centers in northern Vietnam. The trial included 2037 patients for whom antibiotic use was recorded. In total, 1017 patients were assigned to receive CRP point-of-care testing, and 1019 patients were assigned to receive routine care. Among the CRP point-of-care group, 115 patients were excluded in the intention-to-treat analysis, as were 72 patients in the routine care group.
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The number of patients who used antibiotics within 14 days was 581, or 64%, of 902 in the CRP group, compared with 738 (78%) of 947 in the control group. The investigators saw "highly significant differences" in both children and adults, with "substantial heterogeneity" of the intervention effect across the 10 centers included in the study.

Overall, 140 patients in the CRP group and 137 patients in the routine care group missed urine tests on day 3, 4, or 5. Antibiotic activity in urine on day 3, 4, or 5 was found in 267 (30%) of 877 patients in the CRP group vs 314 (36%) of 882 patients in the routine treatment group, while time to resolution of symptoms was similar in both groups. In addition, adverse events were rare, with no deaths and 14 hospital admissions (6 in the CRP group and 8 in the control group).

The results show that "adding a point of care test for C-reactive protein can assist primary care physicians in making better informed decisions on which respiratory infections patients to treat with antibiotics," said study coauthor Jochen W. L. Cals, MD, PhD, from the Department of Family Medicine at Maastricht University in the Netherlands.

This trial in Vietnam is "exactly in line" with previous trials conducted in Western European countries such as the Netherlands and the United Kingdom, "which also showed that [general practitioner’s] use of CRP point of care safely reduces antibiotic prescribing for mostly self-limiting respiratory infections," Dr Cals said.

"The test helps physicians to rule out serious infections in their patients, and this will also help to better explain nonprescribing decisions to patients," he said. "It is exciting that this large trial in an Asian country like Vietnam provides similar results.”

—Mark McGraw

Reference

Do NTT, Ta NTD, Tran NTH, et al. Point-of-care C-reactive protein testing to reduce inappropriate use of antibiotics for non-severe acute respiratory infections in Vietnamese primary health care: a randomised controlled trial [published online August 2, 2016]. Lancet Glob Health. doi:10.1016/S2214-109X(16)30142-5.