A ‘pragmatic guide’ for GPs on use of point-of-care C-reactive protein (CRP) has been published by the Primary Care Respiratory Society in a bid to cut antibiotic prescribing.

An expert panel of PCRS members have developed algorithms for use of CRP testing in both COPD exacerbations and respiratory tract infections in general to support uptake of the technology in general practice.

It follows the experience of other countries such as the Netherlands in adopting point of care CRP tests as part of strict antibiotic stewardship leading them to use fewer antibiotics than any other European country.

Several trials, including a large English study published in 2019 in COPD patients have shown dramatic reductions in use of antibiotics when CRP testing is introduced but without any added harms, the PCRS said.

NICE 2014 guidelines on pneumonia included the use of point of care testing for CRP but were withdrawn during Covid, the PCRS guidance notes.

There have been several barriers to the use of CRP testing in primary care including determining the best model for implementing its use in general practice and funding its use.

Professor Jonathan Cooke, visiting professor in infectious diseases and immunity at Imperial College London and co-author of the guidelines said the issue seemed to have fallen between the gaps of various committees and organisations and so had not been taken up.

‘Unless there is prescriptive guidance from the centre to make these barriers come down it won’t happen,’ he said. ‘There have been a number of pilots but no-one has put a firm recommendation together to implement it. At the moment it’s not joined up.’

He added: ‘The technology exists, it’s a case of driving it through and once you do the advantages are enormous. We did a study in general practice in Manchester and there was a 50% reduction in antibiotic prescribing.’

The PCRS guidance said the clear algorithms they had developed should help improve the use of these diagnostic tests in primary care.

Triage steps include ruling out Covid-19 and influenza, taking account of other symptoms and using the point of care CRP test if the prescriber feels antibiotics are probably needed.

In someone with a respiratory tract infection, this can help determine when if they are not needed, if a delayed prescription may be warranted or if they should be prescribed.

Or in patients with COPD the algorithm and CRP test can help indicate when antibiotics may be needed, but also taking into account if purulent sputum is present.

In the guidance, the PCRS also called on NICE to re-open the review of the current COPD management guidelines and come to a position on the use of point of care CRP testing.

‘Without national guidance, the PCRS panel expressed concern that the NHS could face “postcode diagnostics” and, possibly, differences in antimicrobial resistance patterns’, it concluded.

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