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The Feasibility of C-Reactive Protein Point-of-Care Testing to Reduce Overuse of Antibiotics in Children with Acute
Elvira Isaeva1, Azamat Akylbekov2, Joakim Bloch3
1Allergology Department, National Centre of Maternity and Childhood Care (NCMCC), Bishkek, Kyrgyzstan.
Insights
In Kyrgyzstan, C-reactive protein (CRP) testing guided antibiotic use in children with acute respiratory tract infections (ARTI), significantly reducing antibiotic prescriptions. The pilot study proved feasible and safe, paving the way for a larger trial.
Area of Science:
- Pediatric infectious diseases
- Clinical microbiology
- Public health interventions
Background:
- High morbidity from acute respiratory tract infections (ARTI) in Kyrgyz children.
- Inappropriate antibiotic prescribing by healthcare workers (HCW) due to various factors.
- Need for point-of-care testing (POCT), like C-reactive protein (CRP), to guide antibiotic decisions.
Purpose of the Study:
- To assess the feasibility of methods for a randomized controlled trial (NCT05195866) on CRP-guided antibiotic stewardship.
- To evaluate the implementation of CRP POCT in primary care for children with ARTI.
- To examine the safety and effectiveness of CRP-guided treatment in a pilot setting.
Main Methods:
- Training HCWs in rural Kyrgyzstan on CRP POCT and result interpretation.
- Randomly assigning children (6 months–12 years) with respiratory symptoms to CRP-guided or standard care.
- Following up children for 14 days via telephone calls.
Main Results:
- The CRP POCT and trial procedures were well-accepted by participants and HCWs.
- Antibiotic use was significantly lower in the CRP-guided group compared to standard care.
- No safety concerns were identified; children in both groups recovered similarly.
Conclusions:
- CRP-guided antibiotic stewardship is feasible and safe for children with ARTI in primary care.
- The pilot study provides satisfactory evidence for the effectiveness of CRP POCT in reducing antibiotic prescriptions.
- Minor adjustments are needed for the main COORDINATE trial, particularly regarding participant follow-up data collection.
Background:
In Kyrgyzstan, the morbidity prevalence of and morbidity from acute respiratory tract infections (ARTI) in children is high. Local healthcare workers (HCW) often prescribe antibiotics that are not indicative due to a mix of professional and societal factors. It is suggested to precede with a decision on antibiotics by a point-of-care test (POCT) on the appropriateness of the treatment, eg, a measurement of C-reactive protein (CRP). CRP-guided antibiotic stewardship in children with ARTI has not previously been studied in Central Asia.
Purpose:
This pilot study was conducted to examine the feasibility of the methods and procedures to be used in the upcoming randomised controlled COORDINATE clinical trial (NCT05195866) and in daily clinical practice in primary care.
Patients And Methods:
HCWs from three selected rural healthcare facilities were trained in the CRP POCT and in interpretation of results. Children aged 6 months to 12 years attending the primary healthcare facilities with respiratory symptoms were randomly assigned to CRP-guided management or standard care, guided by clinical findings only. Children were followed up for 14 days by scheduled telephone calls to caregivers.
Results:
Eighty-one children participated in this pilot study. The CRP POCT and the trial procedures were acceptable to the target group as well as to the HCWs. Children from both groups recovered equally well, with an observed significant lower use of antibiotics in the CRP group. HCWs generally adhered to the CRP guidelines, and only once was an antibiotic prescribed despite low CRP results. No safety concerns were observed. Four parents provided wrong phone numbers impeding follow-up. We will collect all mobile phone numbers in the household for the main trial.
Conclusion:
The pilot provided satisfactory results, suggesting that the COORDINATE trial of CRP POCT is effective, feasible with minor adjustments and without apparent safety concerns for the participants.
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