C-reactive protein point-of-care testing and complementary strategies to improve antibiotic stewardship in children with acute respiratory infections in primary care

Frontiers in Pediatrics

Pediatrics

Lars Bjerrum¹  Rogier Hopstaken²  Carl Llor³  Annamaria Staiano⁴  Hasse Melbye⁵  Andreas Plate⁶  Jan Y. Verbakel⁷  Oliver van Hecke⁸  Ivan Gentile⁹ 

[1] Centre for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark;Department of General Practice, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, Netherlands;Department of Public Health and Primary Care, University of Southern Denmark, Odense, Denmark;Department of Translational Medical Sciences, University of Naples “Federico II”, Naples, Italy;General Practice Research Unit, Department of Community Medicine, The Arctic University of Norway, Tromso, Norway;Institute of Primary Care, University and University Hospital Zurich, Zurich, Switzerland;NIHR Community Healthcare Medtech and IVD Cooperative, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom;EPI-Centre, Department of Public Health and Primary Care, Academisch Centrum Voor Huisartsgeneeskunde, Leuven & NIHR Community Healthcare Medtech and IVD cooperative, Leuven, Belgium;Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom;NIHR Community Healthcare Medtech and IVD Cooperative, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom;Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy;

关键词: c-reactive protein;    antibiotic prescribing;    antibiotic stewardship;    antimicrobial resistance;    point-of-care testing;    respiratory tract infections;    children;   

DOI  :  10.3389/fped.2023.1221007

 received in 2023-05-22, accepted in 2023-09-25,  发布年份 2023

来源: Frontiers

【 摘 要 】

This paper provides the perspective of an international group of experts on the role of C-reactive protein (CRP) point-of-care testing (POCT) and complementary strategies such as enhanced communication skills training and delayed prescribing to improve antibiotic stewardship in the primary care of children presenting with an acute illness episode due to an acute respiratory tract infection (ARTI). To improve antibiotics prescribing decisions, CRP POCT should be considered to complement the clinical assessment of children (6 months to 14 years) presenting with an ARTI in a primary care setting. CRP POCT can help decide whether a serious infection can be ruled out, before deciding on further treatments or management, when clinical assessment is unconclusive. Based on the evidence currently available, a CRP value can be a valuable support for clinical reasoning and facilitate communication with patients and parents, but the clinical assessment should prevail when making a therapy or referral decision. Nearly half of children tested in the primary care setting can be expected to have a CRP value below 20 mg/l, in which case it is strongly suggested to avoid prescribing antibiotics when the clinical assessment supports ruling out a severe infection. For children with CRP values greater than or equal to 20 mg/l, additional measures such as additional diagnostic tests, observation time, re-assessment by a senior decision-maker, and specialty referrals, should be considered.

【 授权许可】

Unknown   
© 2023 Staiano, Bjerrum, Llor, Melbye, Hopstaken, Gentile, Plate, van Hecke and Verbakel.