Related Experiment Video
Updated: Jul 10, 2026
One-day Workflow Scheme for Bacterial Pathogen Detection and Antimicrobial Resistance Testing from Blood Cultures
Published on: July 9, 2012
Antibiotic selection patterns in acutely febrile new outpatients with or without immediate testing for C reactive
Y Takemura1, K Ebisawa, H Kakoi
1Department of Laboratory Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan. yutakemu@interlink.or.jp
Background:
Excessive use of broad spectrum antibiotics is related to the spread of drug resistant bacterial strains in the community.
Aim/Methods:
The effects of immediate testing for C reactive protein (CRP) and white blood cell count (WBC) on physicians' choices of antibiotic was investigated in patients with acute infection. Acutely febrile new outpatients were randomised into two groups: group 1 (147 patients) underwent CRP and WBC testing before initial consultation (advance testing). Prescriptions were compared with those in group 2 (no advance testing; 154 patients).
Results:
In non-pneumonic acute respiratory tract infections, 61 (58%) and 122 (91%) of group 1 and 2 patients were prescribed antibiotics, respectively. Cefcapene pivoxil (third generation cephalosporin) and amoxicillin were the most frequently chosen drugs for group 1 and 2, respectively. Total prescriptions of newer, extended spectrum antibiotics (cefcapene pivoxil and clarithromycin (advanced macrolide)) were reduced by 25% in group 1, although they increased in rate (41 (67%) v 55 (45%) prescriptions) because of the decreased prescription of amoxicillin. In group 1, cefcapene pivoxil was preferentially selected when WBC values were greater than 9 x 10(9)/litre. Prescription shifted to macrolides (mainly clarithromycin) in patients without leucocytosis. Patient treatment outcome did not significantly differ between the two groups.
Conclusions:
The availability of CRP and WBC data during initial consultation greatly reduced prescription of amoxicillin, but had a lesser effect on newer, potent, broad spectrum antibiotics.
Insights
Immediate C-reactive protein (CRP) and white blood cell count (WBC) testing reduced antibiotic prescriptions for acute infections. While amoxicillin use decreased, the impact on newer broad-spectrum antibiotics was less pronounced.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Pharmacology
Background:
- Excessive antibiotic use fuels the rise of drug-resistant bacteria.
- Targeted diagnostic testing can inform antibiotic prescribing practices.
Purpose of the Study:
- To evaluate the impact of immediate C-reactive protein (CRP) and white blood cell count (WBC) testing on physician antibiotic choices in acute infections.
Main Methods:
- A randomized controlled trial involving acutely febrile outpatients.
- Group 1: Received CRP and WBC testing before initial consultation (advance testing).
- Group 2: No advance testing; served as the control group.
Main Results:
- Antibiotic prescriptions were lower in the advance testing group (58% vs. 91%).
- Amoxicillin use significantly decreased in the advance testing group.
- Prescription of newer, extended-spectrum antibiotics was reduced by 25% in the advance testing group, with shifts towards macrolides in specific patient subgroups.
- No significant difference in patient treatment outcomes between groups.
Conclusions:
- Advance CRP and WBC testing effectively reduced amoxicillin prescriptions.
- The impact of advance testing on newer, potent, broad-spectrum antibiotic prescribing was less substantial.
- Diagnostic test availability influences antibiotic stewardship but requires nuanced strategies for optimal impact.
Related Concept Videos
00:57Antibiotic Selection
01:30Pneumonia III: Complications and Assessment
01:30Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
01:26Urine Studies II: Urine Culture and Sensitivity Test