Viewpoint: How CRP testing can help GPs beat antimicrobial resistance

Point-of-care testing for antimicrobial resistance can help GPs play a major role in bringing the UK in line with Europe's most responsible users of antibiotics, says Professor Jonathan Cooke. Writing for GPonline, he makes the case for wider use of tests in primary care.

Prescription: tests could help GPs choose when to give out antibiotics
Prescription: tests could help GPs choose when to give out antibiotics

Almost 80% of antibiotic prescribing in the UK is undertaken by GPs and over half of all prescriptions written for respiratory tract infections (RTIs).

Despite many proclamations that government is tackling this, the UK sits in the middle of the European antibiotic prescribing rates lists, well above countries like the Netherlands.

Antimicrobial resistance is now a global issue. It is directly related to antibiotic prescribing and with few new agents coming onto the market better stewardship of existing agents is essential if Society is to avoid being overwhelmed by infections of resistant organisms.

CCGs will receive quality premium incentives to encourage reductions in antibiotic prescribing and the CQC has started to use antibiotic prescribing as a quality indicator for GP practices.

Primary care testing

A report last month, Straight to the Point, by a multidisciplinary panel of healthcare professionals, summarises evidence around measuring C-reactive protein (CRP) levels using point of care testing (POCT) in primary care. CRP-POCT is an effective and cost-effective means to assist clinicians differentiate viral and self-limiting bacterial RTIs from more serious infections that require antibiotics. The report makes recommendations to help healthcare professionals, policy makers and CCGs facilitate implementation and uptake of CRP-POCT.

The evidence for using CRP-POCT is compelling and summarised in a recent Cochrane review of six randomised or cluster-randomised clinical trials where those patients tested subsequently received up to 41% fewer prescriptions for antibiotics.

Professor Jonathan CookeCRP-POCT has also been incorporated into current NICE and PHE guidance for serious RTIs and the latest RCGP/PHE TARGET Toolkit update.

CRP-POCT offers a simple and effective diagnostic instrument for creating greater precision alongside clinical assessment for GPs and their patients presenting with symptoms of RTI. Indeed the use of CRP-POCT offers a very effective negative predictive test for when not to prescribe any antibiotics.

Sharing CRP-POCT results with patients has been shown to improve patient satisfaction that they do not require any antibiotics and allay GPs fears that they might be missing a treatable infection.

The CRP-POCT can have results within 5 minutes from a finger prick blood sample and offers a move towards diagnostic precision for RTIs in the GP surgery.

CRP-POCT has also been shown to be cost-effective compared with previous clinical management strategies and, alongside validated education strategies, offers GPs an effective way of helping to reduce the burden of antibiotic prescribing and reducing the rise in AMR.

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