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C-reactive protein testing does not decrease antibiotic use for acute cough illness when compared to a clinical

Ralph Gonzales¹, Eva M Aagaard, Carlos A Camargo

¹Department of Medicine, University of California, San Francisco, San Francisco, California 94118, USA.

The Journal of Emergency Medicine

|December 20, 2008

Summary

This summary is machine-generated.

Point-of-care C-reactive protein (CRP) testing did not reduce antibiotic prescribing for adults with acute cough in the emergency department. CRP testing showed potential in guiding antibiotic decisions when results were clearly normal or indeterminate.

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Area of Science:

Emergency Medicine
Clinical Diagnostics
Infectious Disease Management

Background:

Antibiotic overuse is prevalent in emergency departments for acute cough illnesses.
Clinical decision support tools are being explored to optimize antibiotic prescribing.

Purpose of the Study:

To assess the impact of point-of-care C-reactive protein (CRP) testing on antibiotic treatment decisions for adults with acute cough in an emergency setting.

Main Methods:

A randomized controlled trial was conducted in a US urban emergency department.
Adults with acute cough (≤ 21 days) were randomized to receive care with or without CRP testing.
Treatment recommendations were guided by a clinical algorithm, with CRP levels integrated for the intervention group.

Main Results:

No significant difference in overall antibiotic or chest X-ray use was observed between CRP-tested and control groups.
However, among CRP-tested patients, those with normal CRP levels received antibiotics significantly less often than those with indeterminate levels (20% vs. 50%).

Conclusions:

Point-of-care CRP testing, when used with a clinical algorithm, did not reduce overall antibiotic prescribing for acute cough in the emergency department.
CRP testing may offer value in differentiating treatment decisions when results are clearly normal or indeterminate.