Influence of point-of-care C-reactive protein testing on antibiotic prescription habits in primary care in the Netherlands

• Published in: Family practice Vol. 35; no. 2; pp. 179 - 185
• Main Authors: Schuijt, Tim J, Boss, David S, Musson, Ruben E A, Demir, Ayşe Y
• Format: Journal Article
• Language: English
• Published: UK Oxford University Press 27.03.2018
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; C-Reactive Protein - analysis; Female; Guideline Adherence; Humans; Male; Middle Aged; Netherlands; Point-of-Care Testing - statistics & numerical data; Practice Guidelines as Topic; Practice Patterns, Physicians' - statistics & numerical data; Primary Health Care - statistics & numerical data; Prospective Studies; Young Adult; Netherlands; respiratory tract infections; primary health care; C-reactive protein; Antibiotics; point-of-care
• ISSN: 0263-2136; 1460-2229
• DOI: 10.1093/fampra/cmx081

Abstract Background Bacterial resistance to antibiotics represents a serious global challenge that is associated with high morbidity and mortality. One of the most important causes of this threat is antibiotic overuse. The Dutch College of General Practitioners (DCGP) recommends the use of point-of-care (POC) testing for C-reactive protein (CRP) in two guidelines (‘Acute Cough’ and ‘Diverticulitis’) to achieve a more sensible prescription pattern of antibiotics. Objective To evaluate the use of POC-CRP testing in light of the DCGP guidelines and the effect of CRP measurements on antibiotic prescription policy in primary care. Methods In a prospective observational study, which included 1756 patients, general practitioners (GPs) were asked to complete a questionnaire after every POC-CRP testing, stating the indication for performing the test, the CRP result and their decision whether or not to prescribe antibiotics. Indications were verified against the DCGP guidelines and categorized. Antibiotic prescription was evaluated in relation to CRP concentrations. Results and Conclusion Indications to perform POC-CRP test and the prescription pattern of antibiotics based on CRP value varied considerably between GPs. Differences in antibiotic prescription rate were most obvious in patients who presented with CRP values between 20 and 100 mg/l, and could in part be explained by the indication for performing POC-CRP test and patient age. Most GPs followed the DCGP guidelines and used low CRP values to underpin their decision to refrain from antibiotic prescription. Peer-based reflection on differences in POC-CRP usage and antibiotic prescription rate amongst GPs may further nourish a more critical approach to prescription of antibiotics.