Point-of-care C-reactive protein to assist in primary care management of children with suspected non-serious lower respiratory tract infection: a randomised controlled trial
Background: Overprescription of antibiotics for lower respiratory tract infections (LRTIs) in children is common, partly due to diagnostic uncertainty, in which case the addition of point-of-care (POC) C-reactive protein (CRP) testing can be of aid. Aim: To assess whether use of POC CRP by the GP re...
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| Format: | Article |
| Language: | English |
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Royal College of General Practitioners
2018-07-01
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| Series: | BJGP Open |
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| Online Access: | https://bjgpopen.org/content/2/3/bjgpopen18X101600 |
| _version_ | 1818127755092426752 |
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| author | Marjolein JC Schot Ann Van den Bruel Berna DL Broekhuizen Jochen WL Cals Eveline A Noteboom Walter Balemans Rogier M Hopstaken Sanne van Delft Niek J de Wit Theo JM Verheij |
| author_facet | Marjolein JC Schot Ann Van den Bruel Berna DL Broekhuizen Jochen WL Cals Eveline A Noteboom Walter Balemans Rogier M Hopstaken Sanne van Delft Niek J de Wit Theo JM Verheij |
| author_sort | Marjolein JC Schot |
| collection | DOAJ |
| description | Background: Overprescription of antibiotics for lower respiratory tract infections (LRTIs) in children is common, partly due to diagnostic uncertainty, in which case the addition of point-of-care (POC) C-reactive protein (CRP) testing can be of aid. Aim: To assess whether use of POC CRP by the GP reduces antibiotic prescriptions in children with suspected non-serious LRTI. Design & setting: An open, pragmatic, randomised controlled trial in daytime general practice and out-of-hours services. Method: Children between 3 months and 12 years of age with acute cough and fever were included and randomised to either use of POC CRP or usual care. Antibiotic prescription rates were measured and compared between groups using generalising estimating equations. Results: There was no statistically significant reduction in antibiotic prescriptions in the GP use of CRP group (30.9% versus 39.4%; odds ratio [OR] 0.6; 95% confidence interval [CI] = 0.29 to 1.23). Only the estimated severity of illness was related to antibiotic prescription. Forty-six per cent of children had POC CRP levels <10mg/L. Conclusion: It is still uncertain whether POC CRP measurement in children with non-serious respiratory tract infection presenting to general practice can reduce the prescription of antibiotics. Until new research provides further evidence, POC CRP measurement in these children is not recommended. |
| first_indexed | 2024-12-11T07:22:23Z |
| format | Article |
| id | doaj.art-9b3b71f24c1748e59d66259901182ec9 |
| institution | Directory Open Access Journal |
| issn | 2398-3795 |
| language | English |
| last_indexed | 2024-12-11T07:22:23Z |
| publishDate | 2018-07-01 |
| publisher | Royal College of General Practitioners |
| record_format | Article |
| series | BJGP Open |
| spelling | doaj.art-9b3b71f24c1748e59d66259901182ec92022-12-22T01:16:04ZengRoyal College of General PractitionersBJGP Open2398-37952018-07-012310.3399/bjgpopen18X101600Point-of-care C-reactive protein to assist in primary care management of children with suspected non-serious lower respiratory tract infection: a randomised controlled trialMarjolein JC Schot0Ann Van den Bruel1Berna DL Broekhuizen2Jochen WL Cals3Eveline A Noteboom4Walter Balemans5Rogier M Hopstaken6Sanne van Delft7Niek J de Wit8Theo JM Verheij9Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, NetherlandsDepartment of Primary Care Health Sciences, University of Oxford, Oxford, UKGeneral Practice de Bongerd, Borculo, NetherlandsDepartment of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, NetherlandsJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, NetherlandsJulius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, NetherlandsStar-SHL, Etten-Leur, NetherlandsSaltro Diagnostic Center for Primary Care, Utrecht, NetherlandsJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, NetherlandsJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, NetherlandsBackground: Overprescription of antibiotics for lower respiratory tract infections (LRTIs) in children is common, partly due to diagnostic uncertainty, in which case the addition of point-of-care (POC) C-reactive protein (CRP) testing can be of aid. Aim: To assess whether use of POC CRP by the GP reduces antibiotic prescriptions in children with suspected non-serious LRTI. Design & setting: An open, pragmatic, randomised controlled trial in daytime general practice and out-of-hours services. Method: Children between 3 months and 12 years of age with acute cough and fever were included and randomised to either use of POC CRP or usual care. Antibiotic prescription rates were measured and compared between groups using generalising estimating equations. Results: There was no statistically significant reduction in antibiotic prescriptions in the GP use of CRP group (30.9% versus 39.4%; odds ratio [OR] 0.6; 95% confidence interval [CI] = 0.29 to 1.23). Only the estimated severity of illness was related to antibiotic prescription. Forty-six per cent of children had POC CRP levels <10mg/L. Conclusion: It is still uncertain whether POC CRP measurement in children with non-serious respiratory tract infection presenting to general practice can reduce the prescription of antibiotics. Until new research provides further evidence, POC CRP measurement in these children is not recommended.https://bjgpopen.org/content/2/3/bjgpopen18X101600Point-of-care CRP testinglower respiratory tract infectionchildrengeneral practicec reactive protein |
| spellingShingle | Marjolein JC Schot Ann Van den Bruel Berna DL Broekhuizen Jochen WL Cals Eveline A Noteboom Walter Balemans Rogier M Hopstaken Sanne van Delft Niek J de Wit Theo JM Verheij Point-of-care C-reactive protein to assist in primary care management of children with suspected non-serious lower respiratory tract infection: a randomised controlled trial BJGP Open Point-of-care CRP testing lower respiratory tract infection children general practice c reactive protein |
| title | Point-of-care C-reactive protein to assist in primary care management of children with suspected non-serious lower respiratory tract infection: a randomised controlled trial |
| title_full | Point-of-care C-reactive protein to assist in primary care management of children with suspected non-serious lower respiratory tract infection: a randomised controlled trial |
| title_fullStr | Point-of-care C-reactive protein to assist in primary care management of children with suspected non-serious lower respiratory tract infection: a randomised controlled trial |
| title_full_unstemmed | Point-of-care C-reactive protein to assist in primary care management of children with suspected non-serious lower respiratory tract infection: a randomised controlled trial |
| title_short | Point-of-care C-reactive protein to assist in primary care management of children with suspected non-serious lower respiratory tract infection: a randomised controlled trial |
| title_sort | point of care c reactive protein to assist in primary care management of children with suspected non serious lower respiratory tract infection a randomised controlled trial |
| topic | Point-of-care CRP testing lower respiratory tract infection children general practice c reactive protein |
| url | https://bjgpopen.org/content/2/3/bjgpopen18X101600 |
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