Point-of-care C-reactive protein testing to optimise antibiotic use in a primary care urgent care centre setting

摘要

The rate of antimicrobial prescribing in UK general practice is falling year on year and data from the Swindon Clinical Commissioning Group (CCG) area are no exception.1 However, looking at the local data more closely, there appeared to be an increasing trend in antimicrobial prescribing in the local urgent care centre, which included broad spectrum increase, which was at odds with local usage within ‘in-hours’ general practice. Most UK general practices prescribe antibiotics for respiratory tract infections at rates that are not clinically justified. Around 48% of patients presenting to a general practitioner (GP) with symptoms of cough or bronchitis will receive an antibiotic, although the majority of these infections are of viral origin and therefore antibiotics are not required.2 Identifying strategies to help clinicians reduce unnecessary antibiotic prescribing in common infections is a key aim within the Department of Health’s ‘UK Five Year Antimicrobial Resistance Strategy’.3 Backup (or delayed) prescribing can reduce antibiotic consumption. Studies have shown that fewer than 40% of patients given a backup antibiotic will use it.4 Point-of-care testing (POCT) of C-reactive protein (CRP) in primary care is not widespread in the UK but is more common in other European countries. The?National Institute for Health and Care Excellence (NICE) recommends point-of-care (POC)?CRP testing in primary care to aid diagnosis in guideline CG191 ‘Pneumonia in adults: diagnosis and management’.2 Based on the recommendations in this guidance, a rapid POCT machine was installed.