A randomized managed superiority trial in France discovered that use of a speedy point-of-care check that may assist clinicians decide who may profit from antibiotics didn’t cut back antibiotic prescribing for kids or adults with suspected respiratory tract infections (RTIs).
The findings have been printed yesterday in Scientific Microbiology and An infection.
Distinguishing between viral and bacterial infections
Respiratory infections are one of many major indications for antibiotic prescribing in outpatient settings in France and different international locations, although antibiotics are sometimes pointless as a result of RTIs are ceaselessly attributable to viruses. Whereas sufferers with bacterial infections profit from antibiotics, pointless antibiotic prescribing for viral RTIs contributes to antibiotic resistance and may result in hostile occasions.
Level-of-care testing for C-reactive protein (CRP POCT) is without doubt one of the instruments clinicians can use to distinguish between a viral and bacterial infections. CRP is a biomarker for irritation present in earlier research to cut back antibiotic prescribing for non-severe respiratory infections.
The trial, performed within the places of work of 26 basic practitioners (GPs) in Paris from October 2019 to March 2023, assigned 207 sufferers ages 3 and older with clinically suspected RTIs to obtain CRP POCT. GP’s within the CRP POCT group used a finger-prick blood check that may return outcomes inside 2 minutes and got antibiotic prescribing steerage primarily based on CRP ranges, however have been free to prescribe therapies based on their scientific judgement.
A management group of 197 sufferers was not examined for CRP ranges.
The first endpoint of the trial was the speed of antibiotic prescribing in each teams. Secondary outcomes have been charges of prescribing for particular age brackets: 3 to 17 (kids), 18 to 64 (adults), and age 65 and older (aged sufferers).
To show superiority, investigators focused a 15% discount in antibiotic prescribing for the CRP POCT group.
The outcomes, nonetheless, confirmed that antibiotic prescribing charges have been comparable in each teams. A complete of 183 sufferers have been prescribed antibiotics by their GPs — 89 of 207 sufferers (43%) within the CRP POCT group in contrast with 94 of 197 (47.4%) within the management group (distinction, –4.7 share factors; 95% confidence interval [CI]–14.4 to five.0).
The antibiotic-prescribing charges within the age brackets of three to 17 years, 18 to 64 years, and 65 years and older have been respectively 20%, 37.6%, and 65% within the CRP POCT group and 21.9%, 43.9%, and 72.5% within the management group (distinction, –1.9, –6.3, and –7.5 share factors, respectively). Total, 75% of the GPs within the CRP POCT group adopted the CRP-based antibiotic suggestions.
“This randomized research performed amongst GPs doesn’t verify the utility of CRP POCT at docs’ places of work for deciding whether or not to prescribe antibiotics,” the research authors wrote.
Different measures of utility
The authors notice that whereas the findings battle with earlier research of CRP testing, the outcomes may very well be defined by the very fact all GPs within the research had been skilled in acceptable antibiotic prescribing, and the research solely included sufferers with clinically suspected decrease respiratory tract infections (LRTIs), versus all sufferers with respiratory signs.
This randomized research performed amongst GPs doesn’t verify the utility of CRP POCT at docs’ places of work for deciding whether or not to prescribe antibiotics.
Additionally they counsel lowered antibiotic prescribing will not be the one strategy to measure the utility of CRP testing in outpatient settings. It could additionally make sure that antibiotic prescribing is “properly based,” they are saying. For instance, sufferers with excessive CRP ranges within the trial have been almost all prescribed antibiotics, both for rapid use or later use if their signs didn’t subside.
“These sufferers, who make up a minority (about 18% on this research) of these consulting for respiratory signs, are in danger for bacterial LRTIs that require antibiotic therapy,” they wrote. “A failure to prescribe antibiotics in such instances can result in critical problems.”
The authors stated future analysis ought to examine if a mix of antibiotic stewardship coaching, CRP POCT, speedy diagnostic exams for viral respiratory infections, and lung ultrasounds might extra reliably detect bacterial RTIs.
