Using CRP POCT for reduce the overuse of antimicrobal treatment

05 May 2022
Type of resource
Malaga 2022
Elvira Isaeva, National Centre of Maternity and Childhood Care
Clinical Research Results Abstract Introduction: Case fatality rates for pneumonia in children remain high in Kyrgyzstan and there is a lack of knowledge of which viruses and bacteria cause the disease. Antibiotic resistance patterns of common bacteria remain largely unknown in Kyrgyzstan [1] which makes it challenging for clinicians to choose the right antibiotic to treat children with suspected bacterial pneumonia and sometimes healthcare workers overuse an antibacterial therapy even when the child does not need it. RCT of using CRP (C-reactive protein) point of care test (POCT) to guide antibiotic prescription for respiratory tract infections has been successful in lowering unnecessary antibiotic prescriptions in adults in high income countries but left a small concern for safety in the form of possibly slightly increased risk of hospitalisation in the CRP group [2].Methods: These are results of pilot study of an individual randomised controlled clinical trial with 14 days blinded follow-up. In a pilot study, we calculated, using a questionnaire, how many percent of children recovered from the words of the guardian / parent on days 3, 7 and 14 of the consultation using the phone. In the main study we planned to conduct the full powered blinded RCT and the primary outcome will be an antibiotic prescription within 14 days from the index consultation, measured as proportion of children in each study group who receive an antibiotic. The second primary outcome is patient safety measured as the number of days until recovery.Results: after randomisation, there were 36 children in intervention group, and 39 children in control group (Fig. 1).16.7% of children of Group A (Intervention) have received antibiotics; 83.3% of children of Group A have not received antibiotics; 59% of children of Group B (Control) have received antibiotics; 41% of children of Group B (Control) have received antibiotics (Fig. 2). Recovered children were defined as those parents indicated on the follow-up questionnaire that their child was doing better, good, and excellent. As can be seen, there is no significant difference between the Intervention group (A) and the Usual care group (B) in recovery (Fig.3).Discussion: Already at the stage of the pilot study, it can be seen that due to the CRP POCT, children are prescribed less antibiotics which is important for Kyrgyz primary health care. It can also be seen that the % of recovery according to parents is almost the same in both groups. Why do we prescribe unnecessary antibiotics? Research Idea Abstract Service Development & Evaluation Abstract Declaration of Interest References and Clinical Trial Registry Information