C-reactive protein point-of-care testing for respiratory-tract infections in primary care
Jochen W. L. Cals
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Differentiating self-limiting from serious lower-respiratory-tract infections (LRTI) based on medical history and physical examination is challenging in primary care. Many family physicians (FPs) empirically prescribe antibiotics to most LRTI patients. The use of C-reactive protein (CRP) point-of-care testing as an additional diagnostic tool can enable FPs decrease antibiotics prescribing, without compromising patient recovery. CRP point of care can decrease physician diagnostic uncertainty and may facilitate patient reassurance. The greatest value of CRP point-of-care testing in primary care lies in ruling out serious disease.
A cut-off value of 20 mg/L can be used to withhold antibiotics treatment in most patients with a low value (>75 % of LRTI patients in primary care). Patients with a CRP value higher than 100 mg/L (~5 % of LRTI patients) should receive antibiotics, while patients with intermediately elevated values between 21 and 99 mg/L (20 % of patients) should be carefully assessed based on the combination of medical history, physical examination and CRP value, and a delayed prescription for antibiotics can be considered in selected cases. Based on our findings the use of CRP point-of-care testing in respiratory-tract infections in primary care should only be advocated in LRTI and rhinosinusitis, and only when seeking additional diagnostic or prognostic information or to ensure further patient reassurance.
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