» Articles » PMID: 32895246

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

Overview
Date 2020 Sep 8
PMID 32895246
Citations 33
Authors
Affiliations
Soon will be listed here.
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.

Citing Articles

Protocol for the development of an intervention to improve the use of Point-of-caRE DiagnostICs in the management of respiraTOry tRact infectionS in primary care (the PREDICTORS study).

OShea J, Hughes C, Molloy G, Cadogan C, Vellinga A, Fahey T HRB Open Res. 2025; 7:73.

PMID: 40060198 PMC: 11890267. DOI: 10.12688/hrbopenres.13962.2.


Correlation Between Inflammatory Markers and Pathogenic Bacteria in Children's Winter Respiratory Infections in Xinjiang.

Wang L, Wang W, Wang J, Zhu L, Luo J Int J Gen Med. 2025; 18:331-343.

PMID: 39867248 PMC: 11766147. DOI: 10.2147/IJGM.S499696.


Role of C-reactive protein in disease progression, diagnosis and management.

Ali S, Zehra A, Khalid M, Hassan M, Shah S Discoveries (Craiova). 2024; 11(4):e179.

PMID: 39554800 PMC: 11569793. DOI: 10.15190/d.2023.18.


Point-of-care tests to manage acute respiratory tract infections in primary care: a systematic review and qualitative synthesis of healthcare professional and patient views.

Hoste M, Borek A, Santillo M, Roberts N, Tonkin-Crine S, Anthierens S J Antimicrob Chemother. 2024; 80(1):29-46.

PMID: 39378128 PMC: 11695907. DOI: 10.1093/jac/dkae349.


Effect of Combination of Point-of-Care C-Reactive Protein Testing and General Practitioner Education and Long-Term Effect of Education on Reducing Antibiotic Prescribing for Children Presenting with Acute Infections in General Practice in Latvia: A....

Likopa Z, kivite-Urtane A, Strele I, Pavare J Antibiotics (Basel). 2024; 13(9).

PMID: 39335040 PMC: 11428635. DOI: 10.3390/antibiotics13090867.


References
1.
Htun T, Sun Y, Chua H, Pang J . Clinical features for diagnosis of pneumonia among adults in primary care setting: A systematic and meta-review. Sci Rep. 2019; 9(1):7600. PMC: 6527561. DOI: 10.1038/s41598-019-44145-y. View

2.
McNally M, Curtain J, OBrien K, Dimitrov B, Fahey T . Validity of British Thoracic Society guidance (the CRB-65 rule) for predicting the severity of pneumonia in general practice: systematic review and meta-analysis. Br J Gen Pract. 2010; 60(579):e423-33. PMC: 2944951. DOI: 10.3399/bjgp10X532422. View

3.
Haenssgen M, Charoenboon N, Althaus T, Greer R, Intralawan D, Lubell Y . The social role of C-reactive protein point-of-care testing to guide antibiotic prescription in Northern Thailand. Soc Sci Med. 2018; 202:1-12. PMC: 5910303. DOI: 10.1016/j.socscimed.2018.02.018. View

4.
Hardy V, Thompson M, Keppel G, Alto W, Ashworth Dirac M, Neher J . Qualitative study of primary care clinicians' views on point-of-care testing for C-reactive protein for acute respiratory tract infections in family medicine. BMJ Open. 2017; 7(1):e012503. PMC: 5278283. DOI: 10.1136/bmjopen-2016-012503. View

5.
Williams Jr J, Simel D, Roberts L, Samsa G . Clinical evaluation for sinusitis. Making the diagnosis by history and physical examination. Ann Intern Med. 1992; 117(9):705-10. DOI: 10.7326/0003-4819-117-9-705. View