Impact of point-of-care C reactive protein on antibiotic prescriptions

BMJ Open. 2019 Feb 1;9(1):e025036

Contributed by Dr Abi Manesh

Point of care CRP and now procalcitonin are two markers which have a potential for “diagnostic stewardship” especially in primary and secondary care centres to decrease antibiotic use across various settings viz

  1. Patients who present with febrile illness
  2. Patients with respiratory illness
  3. Patients with exacerbation of airway diseases like COPD

Their positive effects have been documented in many RCTs, importantly among LMICs as well where the burden of AMR is high. In this systematic review, the authors evaluate the impact of POC CRP on antibiotic prescriptions. 11 randomised controlled trials and 8 non-randomised controlled studies and data from 16 064 patients were analysed in this review. All included studies had a high risk of performance and selection bias. Compared with usual care, point-of-care CRP reduced immediate antibiotic prescribing (pooled risk ratio 0.81; 95%CI 0.71 to 0.92), however, at considerable heterogeneity (I2 =72%). This effect increased when guidance on antibiotic prescribing relative to the CRP level was provided (risk ratios of 0.68; 95%CI 0.63 to 0.74 in adults and 0.56; 95%CI 0.33 to 0.95 in children). They found no significant effect of point-of-care CRP testing on patient satisfaction, clinical recovery, reconsultation, further testing and hospital admission.

An important trial which also showed similar findings not included in the current review can be found here. In a high burden setting like India, point of care CRP can be an important adjunct to routine care to decrease antibiotic utilisation without compromising patient safety.