A major challenge in managing patients with acute cough and lower respiratory tract infections (LRTI) is determining which patients will benefit from antibiotic treatment. It is often not feasible for clinicians to order microbiological and/or other investigations for all patients with symptoms of acute respiratory infections. Instead, clinicians generally rely on the patient’s medical history and a basic physical examination.1 However, clinical assessment alone has poor predictive value.2–3 Consequently, antibiotics are often prescribed to those who are unlikely to benefit, contributing to the development of antimicrobial resistance.4–5
A rapid test, point-of-care C-reactive protein (POCCRP) is widely used in Scandinavia to guide antibiotic management for acute cough and LRTI.6–7 Near-patient testing provides results in minutes and so guides antibiotic treatment decisions at the initial consultation.8 Although CRP level in patients with LRTI appear to strongly influence the likelihood of antibiotic prescribing,7 there remains mixed evidence about the diagnostic value of CRP in distinguishing bacterial from viral infection (aetiology), and its prognostic value in indicating potential benefit from antibiotics.9–14 More evidence is needed about whether CRP is an effective diagnostic and prognostic tool in primary care.
The impact of POCCRP on antibiotic prescribing and patient outcomes has been assessed in clinical settings, showing that antibiotic prescribing in patients managed with POCCRP testing was lower than the control group,6 and that POCCRP did not compromise patient recovery. However, the study did not consider multiple outcomes and was limited to one country (the Netherlands); it is unclear whether results are generalisable to other high income countries.
The aims of the work reported here were: first, to evaluate the impact of POCCRP testing in two European countries (Sweden and Norway) on antibiotic prescribing; secondly, to confirm that it did not compromise patient recovery; and thirdly to assess the cost-effectiveness of the test for diagnosing LRTI from a health service perspective. Each is important in the essential purpose of POCCRP, to reduce antimicrobial resistance through improving antibiotic prescribing decisions.
How this fits in
This study is the first to assess the cost-effectiveness of point of care C-reactive protein (POCCRP) in a pragmatic clinical setting using an observational design. The results of this study indicate that POCCRP is a cost-effective tool to aid antibiotic prescribing decisions for acute cough and lower respiratory tract infections.