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Point of care C-reactive protein (CRP) use in primary care with patient with lower respiratory tract infection (community acquired pneumonia (CAP))

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Point of care C-reactive protein (CRP) use in primary care with patient with lower respiratory tract infection (community-acquired pneumonia (CAP)

  • for people presenting with symptoms of lower respiratory tract infection in primary care, consider a point of care C-reactive protein test if after clinical assessment a diagnosis of pneumonia has not been made and it is not clear whether antibiotics should be prescribed (1)
    • use the results of the C-reactive protein test to guide antibiotic prescribing in people without a clinical diagnosis of pneumonia as follows:

      • do not routinely offer antibiotic therapy if the C-reactive protein concentration is less than 20 mg/litre

      • consider a delayed antibiotic prescription (a prescription for use at a later date if symptoms worsen) if the C-reactive protein concentration is between 20 mg/litre and 100 mg/litre

      • offer antibiotic therapy if the C-reactive protein concentration is greater than 100 mg/ litre

Notes:

A systematic review and meta-analysis of primary care studies pointed to a role of point-of-care testing for CRP in significantly reducing antibiotic prescribing at the index consultation for patients with RTIs (2)

  • most patients consulting in general practice have CRP levels less than 20 mg/L
    • by avoiding the administration of antibiotics to patients with such low CRP values, unnecessary use of antibiotics may be reduced (3)

Reference:

  1. NICE (December 2014). Pneumonia- Diagnosis and management of community- and hospital-acquired pneumonia in adults
  2. Huang Y, Chen R, Wu T, Wei X, Guo A. Association between point-of-care CRP testing and antibiotic prescribing in respiratory tract infections: a systematic review and meta-analysis of primary care studies. Br J Gen Pract. 2013;63:e787-e794. doi: 10.3399/bjgp13X674477
  3. Cals JW, Schot MJ, de Jong SA, Dinant GJ, Hopstaken RM. Point-of-care C-reactive protein testing and antibiotic prescribing for respiratory tract infections: a randomized controlled trial. Ann Fam Med. 2010;8:124-133. doi: 10.1370/afm.1090

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