Recommendation for NHSScotland
Using C-reactive protein (CRP) point-of-care testing as part of the holistic clinical assessment of adult patients attending primary care with symptoms of lower respiratory tract infection shows potential as a cost-effective way to target antibiotic prescribing. However, the size of the reduction in antibiotic prescribing and the likely impact on clinical practice is unknown. There is little published evidence on the use of the test in children or older people. Additional piloting, with monitoring and evaluation, should be undertaken by the organisations in Scotland with responsibility for diagnostic testing, prior to any widespread implementation of CRP testing.
NHSScotland is required to consider the Scottish Health Technologies Group (SHTG) advice.
What were we asked to look at?
We were asked to provide advice on clinical and cost-effectiveness of C-reactive protein point-of-care testing to guide antibiotic prescribing in patients presenting to primary care with symptoms of lower respiratory tract infection, based on the published literature.
Why is this important?
Microbial resistance to antibiotics is a major public health issue. Improving the targeting of antibiotics to those patients who are most likely to benefit is one strategy for addressing this issue. Around 80% of medical antibiotic use is in primary care and, of that, 60% is for respiratory infections. Thus it is important to evaluate initiatives which have the potential to reduce unnecessary use of antibiotics for self-limiting respiratory infections.
Scottish Antimicrobial Prescribing Group (SAPG) and The Scottish Health Protection Network Public Health Microbiology Group.