Expert Guidance
Publications of the Expert Group
Expert Group Consensus Statements
Antimicrobial resistance (AMR) is a global challenge that impacts us all. The purpose of the Expert group on CRP* point of care testing to guide antibiotic prescriptions for respiratory illness is to keep our antibiotics effective for future generations
Our endeavors are guided by seven core statements. Consensus regarding these statements has been achieved through extensive review of clinical evidence, group discussion, and experience.
These statements have been further discussed at the Antibiotic Stewardship Conference: from expert consensus to Europe-wide action at the point of care on 29. November 2022 in Brussels.
Together with our conference participants, we searched for ways to act on these insights to protect the effectiveness of antibiotics by reducing overprescribing for respiratory illness in primary care.
*CRP = C-Reactive Protein
Consensus Statements
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Antimicrobial resistance (AMR) is broadly recognized as one of the biggest threats to global health, food security, and development today¹. AMR is the silent pandemic. Without effective action AMR could surpass cancer as one of the leading causes of death worldwide².
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Antibiotic prescribing in humans is directly linked to levels of AMR in individuals, communities, and at a national level³. A substantial proportion of antibiotic overuse comes from prescriptions issued in primary care to adults and children with symptoms of respiratory tract infections (RTIs)⁴,⁵. A large proportion of these antibiotic prescriptions are estimated to be inappropriate⁶,⁷.
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C-reactive protein (CRP) is a biomarker that is used to assess the severity of inflammation and to predict the severity of an infection. Self-limiting infections (whether viral or bacterial) are those that tend to resolve themselves without further treatment. In primary care, approximately 74% of adult patients presenting with symptoms of RTIs have CRP values <20 mg/L, indicating self-limiting infections where antibiotic treatment does not have any additional benefit⁸.
Several systematic reviews and meta-analyses conclude that the use of CRP POCT can safely reduce antibiotic prescribing for adult patients with lower respiratory tract infections (LRTIs)⁴,⁹⁻¹¹. The latest Cochrane Review covering 11 randomized trials observed a mean reduction of antibiotic prescribing of 24% in adults⁴, with one trial even demonstrating a reduction of 42%.¹² Several guidelines for the management of LRTIs already recommend the use of CRP POCT.
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CRP POCT is recommended to confirm the antibiotic prescribing decision for adults presenting in primary care with symptoms of LRTIs⁴,⁹⁻¹³.
CRP POCT adds to the complete understanding of a patient’s situation and adds objective information to support clinical assessment, diagnosis, and further patient treatment or management decision.
CRP results can be used for explanation and support patient-doctor communication, which may be particularly important in regions with relatively high antibiotic use.
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Implementing CRP POCT together with complementary strategies is crucial to optimize antibiotic prescribing without negatively impacting individual patient care. Adding complementary strategies may reduce antibiotic prescribing by more than 60%¹², ¹⁴. These strategies include:
Communication skills training being provided to prescribing clinicians¹²,¹⁴
Safety netting advice being provided as necessary
Clear CRP value cut-off guidance being provided
Delayed prescribing techniques being enabled and used when appropriate¹⁵,¹⁸
Decision Aids being reviewed with patients¹⁹
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Recent reviews and meta-analysis show that CRP POCT can support antibiotic stewardship, safely reducing antibiotic prescriptions by up to 44% for children with acute illness episodes due to RTIs when cut-off guidance is applied, without negative effects on patient outcomes or healthcare processes⁹,¹⁰.
CRP POCT can aid assessment of a child’s situation and the severity of an infection to help inform prescription decisions. While the clinical assessment should always prevail, it is suggested to avoid prescribing antibiotics in most cases with CRP values <20 mg/L.
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Antibiotic overuse in humans and AMR are strongly correlated and the total global economic cost of AMR is very high. Cumulative costs will vary depending on the specific context, but several studies, such as those in the Netherlands, Norway, Sweden, the United Kingdom and Ireland, concluded that CRP POCT is economically viable on top of having beneficial health outcomes.