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C-reactive protein measurement in general practice may lead to lower antibiotic prescribing for sinusitis
Lars Bjerrum1, Bente Gahrn-Hansen, Anders P Munck
1Research Unit of General Practice, University of Southern Denmark, Denmark. lbjerrum@health.sdu.hk
Background:
Symptoms of bacterial sinusitis overlap with viral sinusitis, and it is difficult to distinguish between the two conditions based only on a clinical examination. Uncertain diagnosis results in the significant overuse of antibiotics, which is considered to be one of the most important reasons for development of bacterial resistance to antibiotics. A raised C-reactive protein (CRP) level is an indicator of bacterial infection and the CRP rapid test has been shown to be useful for the diagnosis of bacterial sinusitis in general practice.
Aims:
To examine whether general practitioners (GPs) who use the CRP rapid test in their practice have a lower antibiotic prescribing rate for sinusitis than GPs who do not use the test.
Design Of Study:
Observational design.
Setting:
General practice in Denmark.
Method:
A group of GPs registered all contacts (n = 17 792) with patients who had respiratory tract infections during a 3-week period between 1 November 2001 and 31 January 2002. GPs who used a CRP rapid test were compared with GPs who did not, and the treatment of their patients (n = 1444) with suspected sinusitis was compared.
Results:
A CRP rapid test was used by 77% (n = 281) of the GPs. In the group of GPs using a CRP rapid test, the rate of antibiotic prescribing was 59% (95% confidence interval [CI] = 56 to 62) compared with 78% (95% CI = 73 to 82) in the group of GPs who did not use a CRP test. Performing a CRP rapid test was the factor that exerted the greatest influence on whether the patients were prescribed antibiotics, and the level of CRP had a strong influence on the prescribing rate.
Conclusion:
The CRP rapid test has a substantial influence on the treatment of sinusitis, and implementing the test in general practice may lead to a reduction in antibiotic prescribing to patients with sinusitis.
Insights
Using a C-reactive protein (CRP) rapid test in general practice significantly reduces antibiotic prescribing for sinusitis. This diagnostic tool helps differentiate bacterial from viral infections, combating antibiotic resistance.
Area of Science:
- General Practice
- Infectious Disease Diagnosis
- Antibiotic Stewardship
Background:
- Bacterial and viral sinusitis symptoms are clinically indistinguishable, leading to antibiotic overuse.
- Antibiotic resistance is a major public health concern driven by unnecessary antibiotic prescriptions.
- C-reactive protein (CRP) levels indicate bacterial infection, and rapid tests can aid sinusitis diagnosis.
Purpose of the Study:
- To evaluate if general practitioners (GPs) utilizing CRP rapid tests prescribe fewer antibiotics for sinusitis compared to those who do not.
- To assess the impact of CRP rapid testing on antibiotic prescribing patterns in primary care settings.
Main Methods:
- Observational study conducted in general practices in Denmark.
- Data collected from 17,792 respiratory tract infection contacts over a 3-week period.
- Comparison of antibiotic prescribing rates for 1,444 patients with suspected sinusitis between GPs using and not using CRP rapid tests.
Main Results:
- 77% of GPs used the CRP rapid test.
- Antibiotic prescribing rates were 59% for GPs using the test versus 78% for those not using it.
- CRP rapid test use was the strongest predictor of antibiotic prescription, with CRP levels influencing prescribing decisions.
Conclusions:
- The CRP rapid test significantly influences antibiotic prescribing for sinusitis.
- Widespread implementation of CRP rapid testing in general practice can reduce unnecessary antibiotic prescriptions.
- This approach supports antibiotic stewardship and helps mitigate the development of antibiotic resistance.
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