Cochrane for Clinicians

Putting Evidence into Practice

Point-of-Care C-Reactive Protein Testing to Help Guide Treatment of Acute Respiratory Infections

 


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Am Fam Physician. 2015 Oct 1;92(7):571-572.

Clinical Question

Does point-of-care measurement of C-reactive protein (CRP) reduce inappropriate antibiotic prescribing for patients with acute respiratory infections?

Evidence-Based Answer

Point-of-care CRP testing used as an adjunct to a physician's clinical examination can modestly reduce antibiotic use. Measurement of CRP to guide antibiotic prescription does not appear to affect the duration of illness or recovery, although one study suggests that it increases the risk of hospitalization. The best algorithm is not known, although most state that a CRP level of less than 20 mg per L (190.5 nmol per L) suggests a viral infection. (Strength of Recommendation: B, based on inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

Acute respiratory infections are among the most common symptomatic reasons for visits to family physicians.1,2 These predominantly viral infections are the most common indication for an antibiotic prescription, despite a lack of benefit for most patients.25 An estimated 41 million unnecessary antibiotic prescriptions are written at a cost of $1.1 billion per year for noninfluenza viral respiratory infections.6 Guidelines already advocate the use of CRP to help determine the appropriateness of antibiotics in patients with lower respiratory

Author disclosure: No relevant financial affiliations.


The practice recommendations in this activity are available at http://summaries.cochrane.org/CD010130.

SOURCE:

Aabenhus R, Jensen JU, Jørgensen KJ, Hróbjartsson A, Bjerrum L. Biomarkers as point-of-care tests to guide prescription of antibiotics in patients with acute respiratory infections in primary care. Cochrane Database Syst Rev. 2014;(11):CD010130.

REFERENCES

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1. Hing E, Cherry DK, Woodwell DA. National Ambulatory Medical Care Survey: 2004 summary. Adv Data. 2006;(374):1–33....

2. Steinman MA, Gonzales R, Linder JA, Landefeld CS. Changing use of antibiotics in community-based out-patient practice, 1991–1999. Ann Intern Med. 2003; 138(7):525–533.

3. Zoorob R, Sidani MA, Fremont RD, Kihlberg C. Antibiotic use in acute upper respiratory tract infections. Am Fam Physician. 2012;86(9):817–822.

4. Infectious Diseases Society of America. Choosing Wisely. Five things physicians and patients should question. http://www.choosingwisely.org/societies/infectious-diseases-society-of-america/. Accessed April 27, 2015.

5. Centre for Clinical Practice. Respiratory tract infections—antibiotic prescribing. Prescribing of antibiotics for self-limiting respiratory tract infections in adults and children in primary care. NICE Clinical Guidelines, no. 69. London, United Kingdom: National Institute for Health and Clinical Excellence; 2008:1–121.

6. Fendrick AM, Monto AS, Nightengale B, Sarnes M. The economic burden of non-influenza-related viral respiratory tract infection in the United States. Arch Intern Med. 2003;163(4):487–494.

7. Woodhead M, Blasi F, Ewig S, et al.; Joint Taskforce of the European Respiratory Society and European Society for Clinical Microbiology and Infectious Diseases. Guidelines for the management of adult lower respiratory tract infections—full version. Clin Microbiol Infect. 2011;17(suppl 6):E1–E59.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, Assistant Medical Editor.

A collection of Cochrane for Clinicians published in AFP is available at http://www.aafp.org/afp/cochrane.



 

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