The problem, the consequences, and rapid testing solutions

Lower respiratory tract infection (LRTI) is one of the most common acute reasons for patients to seek urgent medical assessment, accounting for 17 million consultations in the European Union and 11 million in the U.S. each year.1

Despite robust evidence highlighting little or no benefit from antibiotic treatment for most people presenting with respiratory tract infection (RTI) symptoms, these illnesses are still the commonest reason for antibiotic prescribing in primary care.2


Statistics indicate that 90% of RTIs are caused by viruses and, in these cases, antibiotics are unlikely to have any clinical benefit for the patient.In fact, 80% of LRTIs presenting in primary care are acute bronchitis. Despite evidence of little or no benefit from antibiotics, up to 80% of patients consulting for this condition are prescribed them.1

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There is an obvious over-prescription of antibiotics for RTI in primary care. Antibiotic prescribing puts individuals at risk from side effects, encourages help-seeking behavior for mainly self-limiting illnesses, and puts both individuals and society at risk from increasing antibiotic resistance.Most RTIs are harmless, self-limiting and nearly all patients recover without any pharmaceutical intervention. Antibiotic treatment, in some cases, may be directly harmful due to adverse effects.3


 Research indicates that countries’ antibiotic-prescribing rates are linked to resistance rates1,2 and, consequently, that the reduction of unnecessary prescribing, particularly for acute respiratory tract infections (ARTIs), could directly contribute to lower resistance.Interventions such as CRP point-of-care testing can help promote a more prudent use of antibiotics.5,6 Use of point-of-care tests for CRP have been shown to significantly reduce antibiotic prescribing for lower respiratory tract infections without compromising either patients’ recovery or satisfaction with care.7-12 It has also been shown that physicians with access to CRP tests significantly reduced antibiotic prescriptions in patients with rhinosinusitis.13

The Afinion™ CRP test is an important point-of-care assay to help discriminate serious illness such as pneumonia from often self-limiting illness like acute bronchitis and other RTI.14 Afinion™ CRP is a rapid in vitro diagnostic test for quantitative determination of C-reactive protein (CRP) in human blood; helping reduce diagnostic uncertainty and guiding antibiotic decision making during your patient’s visit. The fully automated Afinion™ CRP test provides, with excellent precision and user friendliness, an answer in 3-4 minutes.

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C-reactive protein (CRP) is one of the cytokine induced acute-phase proteins, the levels of which rise during a response to infectious and non-infectious inflammatory processes.16,17 In healthy persons the serum or plasma CRP levels are below 5 mg/L.17,18 As elevated CRP levels are always associated with pathological changes, the CRP assay provides information for the diagnosis, therapy and monitoring of inflammatory diseases.15-18

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View References

  1. Cals, J.W., Butler, C.C., Hopstaken, R.M., Hood, K. and Dinant, G.J. (2009) Effect of point of care testing for C-reactive protein and training in communication skills on antibiotic use in lower respiratory tract infections: cluster randomised trial. BMJ. 2009;338(51):1374. [Online] doi:10.1136/bmj.b1374
  2. Stanton, N., Francis, N.A. and Butler, C.C. (2010) Reducing uncertainty in managing respiratory tract infections in primary care. British Journal of General Practice.
  3. Bjerrum, L. et al. (2010) Health Alliance for Prudent Prescribing, Yield and Use of Antimicrobial Drugs in the Treatment of Respiratory Tract Infections (HAPPY AUDIT). 2010. BioMed Central Family Practice, [Online]. Available at: http://www.biomedcentral.com/1471-2296/11/29 2010, 11:29
  4. Kindmark C-O. The concentration of C-reactive protein in sera from healthy individuals. Scand J Clin Lab Invest 1972; 29:407-11.
  5. Gjelstad, S. et al. (2011) Do general practitioners’ consultation rates influence their prescribing patterns of antibiotics for acute respiratory tract infections? Journal of Antimicrobial Chemotherapy. 2011, 66: 2425-2433 [Online] doi:10.1093/jac/dkr295
  6. Brookes-Howell, L, Hood, K, Cooper, L, Little, P, Theo Verheij T, Coenen, S., Maciek Godycki-Cwirko, M., Melbye, H. ,Borras-Santos, A., Worby, P., Jakobsen, K., Goossens, H., Butler, C. C.
  7. Cooke J, Llor C, Hopstaken R, Dryden M, Butler C et al. Respiratory tract infections (RTIs) in primary care: narrative review of C reactive protein (CRP) point-of-care testing (POCT) and antibacterial use in patients who present with symptoms of RTI. BMJ Open Resp Res 2020;7:e000624. doi:10.1136/ bmjresp-2020-000624 https://bmjopenrespres.bmj.com/content/7/1/e000624
  8. Verbakel JY, Lee JJ, Goyder C et al. Impact of point-of-care C reactive protein in ambulatory care: a systematic review and meta-analysis. BMJ Open 2019;9:e025036. doi:10.1136/bmjopen-2018-025036 https://pubmed.ncbi.nlm.nih.gov/30782747/
  9. Martínez-González NA, Keizer E, Plate A et al. Point-of-Care C-Reactive Protein Testing to Reduce Antibiotic Prescribing for Respiratory Tract Infections in Primary Care: Systematic Review and Meta-Analysis of Randomised Controlled Trials. Antibiotics 2020;9(9):610. DOI: 10.3390/antibiotics9090610 https:// pubmed.ncbi.nlm.nih.gov/32948060/
  10. O’Brien K, Gloeckner L, Jordan K et al. EUnetHTA report 2019. Rapid assessment on other health technologies using the HTA Core Model for Rapid Relative Effectiveness Assessment. C-reactive protein point-of-care testing (CRP POCT) to guide antibiotic prescribing in primary care settings for acute respiratory tract infections (RTIs). EUnetHTA Project ID: OTCA012. https://www.eunethta.eu/wp-content/uploads/2019/02/EUnetHTA_OTCA012_CRP-POCT_31012019.pdf
  11. Aabenhus R, Jensen JUS, Jørgensen KJ, Hróbjartsson A, Bjerrum L. Biomarkers as point-of-care tests to guide prescription of antibiotics in patients with acute respiratory infections in primary care (Review). Cochrane Database of Systematic Reviews 2014, Issue 11
  12. Tonkin-Crine SKG, Tan PS, van Hecke O, Wang K, Roberts NW, McCullough A, Hansen MP, Butler CC, Del Mar CB. Clinician-targeted interventions to influence antibiotic prescribing behaviour for acute respiratory infections in primary care: an overview of systematic reviews. Cochrane Database of Systematic Reviews 2017, Issue 9. Art. No.: CD012252.
  13. van Leeuwen MA, van Rijswijk MH. Acute phase proteins in the monitoring of inflammatory disorders. Baillieres Clin Rheumatol. 1994 Aug;8(3):531-52.
  14. Claus DR, Osmand AP, Gewurz H. Radioimmunoassay of human C-reactive protein and levels in normal sera. J Lab Clin Med 1976; 87:120-8.
  15. Dati F, Schumann G et al. Consensus of a group of professional societies and diagnostic companies on guidelines for interim reference ranges for 14 proteins in serum based on the standardization against the IFCC/BCR/CAP Reference Material (CRM 470). International Federation of Clinical Chemistry. Community Bureau of Reference of the Commission of the European Communities. College of American Pathologists. Eur J Clin Chem Clin Biochem 1996; 34(6):517-20.
  16. Morley J, Kushner I. Serum C-reactive protein levels in disease. Ann NY Acad Sci 1982; 389:406-18.
  17. Kushner I, Rzewnicki DL. The acute phase response: general aspects. Baillieres Clin Rheumatol. 1994 Aug;8(3):513-30.
  18. Pepys MB, Hirschfield GM. C-reactive protein: a critical update. J Clin Invest. 2003 Jun;111(12):1805-12

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