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Published on: August 30, 2018
Out-of-hours antibiotic prescription after screening with C reactive protein: a randomised controlled study
Ingrid Keilegavlen Rebnord1, Hogne Sandvik2, Anders Batman Mjelle3
1National Centre for Emergency Primary Health Care, Uni Research Health, Bergen, Norway Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
Insights
Preconsultation C-reactive protein (CRP) screening for children with fever or respiratory symptoms did not significantly alter antibiotic prescriptions or hospital referrals. This study in Norwegian primary care found no major impact from routine CRP testing before doctor consultations.
Area of Science:
- Pediatrics
- Primary Care Medicine
- Diagnostic Testing
Background:
- Antibiotic overuse is a significant global health concern, contributing to antimicrobial resistance.
- Fever and respiratory symptoms are common reasons for pediatric primary care visits, often leading to antibiotic prescriptions.
- C-reactive protein (CRP) testing can aid in differentiating bacterial from viral infections, potentially guiding antibiotic use.
Purpose of the Study:
- To investigate the impact of preconsultation C-reactive protein (CRP) screening on antibiotic prescribing practices.
- To assess whether CRP screening influences referral rates to hospitals for children presenting with fever or respiratory symptoms.
- To evaluate the effectiveness of CRP testing in low-prevalence settings for serious infections.
Main Methods:
- A randomized controlled observational study was conducted in Norwegian primary care out-of-hours services.
- 401 children aged 0-6 years with fever and/or respiratory symptoms participated.
- Children were randomized to either preconsultation CRP testing or standard care where CRP was ordered at the physician's discretion.
Main Results:
- The antibiotic prescription rate was 26% in the CRP pretested group versus 22% in the control group (not statistically significant).
- Hospital referral rates were 5% in the CRP pretested group compared to 9% in the control group (not statistically significant).
- Parental assessment of illness severity and child's temperature were key predictors for ordering a CRP test.
Conclusions:
- Preconsultation CRP screening does not significantly impact antibiotic prescribing in children with fever or respiratory symptoms in this setting.
- Routine CRP testing before consultations did not lead to a significant change in hospital referral rates.
- The study suggests that CRP screening may not be a decisive factor in altering clinical decisions for antibiotic use or hospital admission in low-prevalence primary care settings.
Objective:
To evaluate the effect of preconsultation C reactive protein (CRP) screening on antibiotic prescribing and referral to hospital in Norwegian primary care settings with low prevalence of serious infections.
Design:
Randomised controlled observational study at out-of-hours services in Norway.
Setting:
Primary care.
Participants:
401 children (0-6 years) with fever and/or respiratory symptoms were recruited from 5 different out-of-hours services (including 1 paediatric emergency clinic) in 2013-2015.
Intervention:
Data were collected from questionnaires and clinical examination results. Every third child was randomised to a CRP test before the consultation; for the rest, the doctor ordered a CRP test if considered necessary.
Outcome Measures:
Main outcome variables were prescription of antibiotics and referral to hospital.
Results:
In the group pretested with CRP, the antibiotic prescription rate was 26%, compared with 22% in the control group. In the group pretested with CRP, 5% were admitted to hospital, compared with 9% in the control group. These differences were not statistically significant. The main predictors for ordering a CRP test were parents' assessment of seriousness of the illness and the child's temperature. Paediatricians ordered CRP tests less frequently than did other doctors (9% vs 56%, p<0.001).
Conclusions:
Preconsultation screening with CRP of children presenting to out-of-hours services with fever and/or respiratory symptoms does not significantly affect the prescription of antibiotics or referral to hospital.
Trial Registration Number:
NCT02496559; Results.
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