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C-reactive protein testing to reduce antibiotic prescribing for acute respiratory infections in adults: a systematic
Kang Zhang1,2,3, Kai Xie1,3, Chenxi Zhang1,3
1Henan University of Chinese Medicine, Zhengzhou, China.
Background:
Antimicrobial resistance (AMR) has become a worldwide public health problem. Abuse of antibiotic in acute respiratory tract infections (ARI) contributes to the increasing AMR. C-reactive protein (CRP) testing may help reduce antibiotic overprescribing, but the available evidence quality varies widely. There is no meta-analysis of CRP testing to guide the antibiotic prescribing for adult ARI. Therefore, we conducted this meta-analysis to determine the effectiveness of CRP testing to guide antibiotic prescribing in adult ARI.
Methods:
We searched the Cochrane Library, PubMed, and EMBASE databases for randomized controlled trials (RCTs) involving our meta-analysis from the establishment of these databases until January 16, 2021. Two reviewers extracted the data separately and pooled the data using RevMan5.3. The evidence quality was appraised strictly with GRADE system.
Results:
Seven studies included with 3,614 patients. Compared with routine care, CRP testing reduced antibiotic prescribing rate at the index consultation significantly [risk ratio (RR) =0.76; 95% confidence interval (CI): 0.68-0.85; P<0.00001], and during 28 days follow-up (RR =0.77; 95% CI: 0.73-0.81; P<0.00001). There were no significant differences between CRP testing and routine care in clinical recovery of patients within 7 days (RR =0.95; 95% CI: 0.90-1.01; P=0.08). Moreover, adverse events were not significantly different between CRP testing and routine care.
Discussion:
CRP testing can reduce the antibiotic prescribing rate at index consultation and during 28 days 
follow-up. These findings support the conclusion that CRP testing is valuable to guide the antibiotic prescribing for adult ARI.
Insights
C-reactive protein (CRP) testing significantly reduces antibiotic prescribing for adult acute respiratory infections (ARI). This meta-analysis confirms CRP testing
Area of Science:
- Clinical Medicine
- Infectious Diseases
- Public Health
Background:
- Antimicrobial resistance (AMR) is a global health crisis exacerbated by antibiotic overuse in acute respiratory infections (ARIs).
- C-reactive protein (CRP) testing shows potential to curb unnecessary antibiotic prescriptions, but evidence quality is inconsistent.
- A meta-analysis was needed to evaluate CRP's effectiveness in guiding antibiotic prescribing for adult ARIs.
Purpose of the Study:
- To determine the effectiveness of C-reactive protein (CRP) testing in guiding antibiotic prescribing for adult patients with acute respiratory infections (ARIs).
- To synthesize evidence from randomized controlled trials (RCTs) on CRP's impact on antibiotic use and patient outcomes.
Main Methods:
- A systematic literature search was conducted across Cochrane Library, PubMed, and EMBASE databases until January 16, 2021.
- Seven randomized controlled trials (RCTs) involving 3,614 patients were included in the meta-analysis.
- Data extraction and analysis were performed using RevMan5.3, with evidence quality appraised using the GRADE system.
Main Results:
- CRP testing significantly reduced antibiotic prescribing rates at initial consultation (RR=0.76) and during 28-day follow-up (RR=0.77) compared to routine care.
- No significant differences were observed in clinical recovery within 7 days (RR=0.95) or adverse events between CRP testing and routine care groups.
- The findings indicate a substantial decrease in antibiotic use without compromising patient recovery or safety.
Conclusions:
- C-reactive protein (CRP) testing is a valuable tool for guiding antibiotic prescribing in adult patients with acute respiratory infections (ARIs).
- Implementing CRP testing can effectively lower antibiotic prescribing rates, addressing concerns about antimicrobial resistance (AMR).
- The study supports the clinical utility of CRP testing in managing adult ARIs.
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