Point-of-care testing for C-reactive protein (CRP) in febrile patients attending primary care reduces antibiotic prescribing, with no difference in clinical outcomes, suggests a new study in The Lancet Global Health.
A multicentre, open-label, randomised controlled trial assessed the effect of two different CRP thresholds (20 mg/L in group A and 40 mg/L in group B) on antibiotic prescribing rates, compared with current practice (control group), among 2410 febrile patients (aged above one year) in primary care settings in Thailand and Myanmar.
During the trial, 318 (39%) of 807 patients in the control group were prescribed an antibiotic by day five, compared with 290 (36%) of 803 patients in CRP group A and 275 (34%) of 800 in CRP group B.
Patients with high CRP concentrations in both CRP groups were more likely to be prescribed an antibiotic.
Reductions in antibiotic prescription were greater in patients with documented fever, respiratory presentation, and for broad-spectrum antibiotics.
There was no evidence of a difference in clinical outcomes between the groups.
This study extends the evidence base from lower-income settings supporting the use of CRP tests to rationalise antibiotic use in primary care patients with an acute febrile illness, the authors concluded.