Authors' objectives: The aim of this collaborative assessment was to evaluate the relative effectiveness and safety of using C-reactive protein (CRP) point-of-care testing (POCT) to guide antibiotic prescribing in patients with acute respiratory tract infections (RTIs) in primary care settings. The relative effectiveness assessment (REA)sought to answer three questions by conducting three separate systematic reviews (SRs)

Authors' results and conclusions: The systematic review of clinical efficacy and safety (SR1) included twelve studies. Seven RCTs with 5,320 patients were included in the meta-analysis for the primary endpoint of prescription (antibiotic prescription at initial consultation i.e. index consultation). The pooled estimate of the RCTs showed a statistically significant reduction in antibiotic prescription at initial consultation in the CRP POCT group compared to standard care (relative risk [RR] 0.76, 95% confidence interval [CI]: 0.67-0.86, I2= 70%). For the accuracy of the diagnostic tests (DTA) (SR2), 15 (highly heterogeneous) studies were identified concerning differences in the criteria used to define a positive test (threshold values), the diagnostic criteria (including the use of CRP values alone or as part of a clinical algorithm), the patient populations and the lack of a universal reference standard for the diagnosis of acute respiratory infections requiring antibiotics. The systematic review of analytical performance was based on 18 studies (SR3). Analytical performance describes the ability of the assay to accurately measure CRP values within an "acceptable" bias (the difference between the measured value and the true value). An acceptable bias of max 15% could be found for some tests. Conclusion: Studies suggest that the use of CRP POCT leads to a statistically significant reduction in the number of patients who present themselves with acute respiratory infections in primary care and receive a prescription for an antibiotic at the initial consultation.

Authors' methods: Three systematic literature searches were carried out in different databases: Clinical efficacy and safety (SR1), accuracy of diagnostic tests (SR2) and analytical performance (SR3).

Project Status: Completed

URL for project: https://aihta.at/page/crp-c-reaktives-protein-messung-bei-akuten-infektionen-der-atemwege-in-der-primaerversorgung/de

Year Published: 2019

URL for published report: http://eprints.aihta.at/1194/1/LBI-HTA_Projektbericht_116.pdf

URL for additional information: http://eprints.aihta.at/1194/

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Austria

Organisation Name: Ludwig Boltzmann Institute for Health Technology Assessment

Contact Address: Ludwig Boltzmann Institute for fuer Health Technology Assessment (LBI-HTA), Garnisongasse 7/rechte Stiege Mezzanin (Top 20), 1090 Vienna, Austria. Tel: +43 1 236 8119 - 0 Fax: +43 1 236 8119 - 99

Contact Name: tarquin.mittermayr@aihta.at

Contact Email: office@aihta.at