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Targeted antibiotic use in primary healthcare

About 80–90% of antibiotics are prescribed in primary healthcare, and up to 80% of these are used to treat acute respiratory tract infections1-3. Most acute respiratory tract infections are caused by viruses, yet, antibiotics are very frequently used to treat these conditions4,5 It is estimated that 50% of all antibiotic prescriptions in primary healthcare are unnecessary2. Excessive and inappropriate use of antibiotics is a main cause of antibiotic resistance, a major global health threat today6,7.

The use of antibiotics in primary healthcare varies considerably between countries, which is unlikely to be caused by differences in frequency of bacterial infections8. A correlation between a high use of antibiotics and higher rate of antibiotic resistance has been observed9,10.Containment of inappropriate and excessive antibiotic use may contribute to slowing down or even reversing the development of antibiotic resistance11,12.

Unnecessary use of antibiotics is also costly: the cost of the antibiotic treatment itself, but in addition the cost of treating unwanted side-effects of antibiotic treatment (e.g. antibiotic associated diarrhea and allergic reactions)13-15.

C-reactive protein (CRP)

Measurement of C-reactive protein (CRP) is helpful in the clinical management of a patient with symptoms of an infection. CRP is present in very low concentrations in the blood of healthy people; 99% have levels of less than 10 mg/l 16. In bacterial infections, CRP concentrations increase markedly16. Elevated concentrations can be detected within 6–12 h after onset of an inflammatory stimulus, reaching maximum within 24–48 h16,17.Concentrations fall rapidly when the patient responds to treatment16. Uncomplicated viral infections mostly induce a very modest CRP elevation or none at all16.

Point-of-care testing for CRP has been found to significantly reduce antibiotic use for respiratory tract infections in primary healthcare18 and in this way it may help to halt the development of antibiotic resistance.  From the healthcare perspective, the use of CRP point-of-care test is also cost-effective19-21.

QuikRead go® CRP assists in deciding on the right treatment

The QuikRead go® CRP tests are a simple tool for quantitative measurement of CRP from fingertip blood samples. When the tests are performed near the patient, the result will be available immediately to support the diagnosis and to guide antibiotic use. When combined with a medical examination and careful clinical judgment, QuikRead go CRP assists the healthcare professional in differentiating between bacterial and viral infections and in identifying those patients who need – and particularly those who do not need – antibiotic therapy.

As CRP concentrations fall rapidly in response to effective treatment, QuikRead go CRP tests are also useful for monitoring the effect of antibiotic treatment.

With accurate information, patients can be more easily reassured that symptomatic treatment will be sufficient. The results obtained using the QuikRead go CRP tests are analytically as accurate as the test results obtained by laboratory analysers.17, 22

QuikRead go CRP allows an evidence-based approach to antibiotic use in primary healthcare, increasing both doctor and patient satisfaction.

Read more:

QuikRead go CRP
QuikRead go CRP+Hb

QuikRead go is not registered in the USA.

QuikRead_go_CRP_Open_kit_web

QuikRead_go_CRP+Hb_Open_kit_with_capillaries_and_plungers_web

Published January, 13 2016

References:

  1. Goossens H, Ferech M, Vander Stichele R, Elseviers M; ESAC Project Group. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet 2005;365(9459):579-87.
  2. The Center for Disease Dynamics, Economics & Policy. 2015. The State of The World's Antibiotics, 2015. CDDEP: Washington, D.C.
  3. Kuyvenhoven MM et al. Outpatient antibiotic prescriptions from 1992 to 2001 in The Netherlands. JAC 2003;52:675-678.
  4. Kenealy T, Arroll B. Antibiotics for the common cold and acute purulent rhinitis. Cochrane Database of Systematic Reviews 2013, Issue 6. Ar t. No.: CD000247
  5. Smith SM, Fahey T, Smucny J, Becker LA. Antibiotics for acute bronchitis. Cochrane Database of Systematic Reviews 2014, Issue 3. Art. No.: CD000245.
  6. CDC. Get Smart: Know When Antibiotics Work. Facts about Antibiotic Resistance. Available at http://www.cdc.gov/getsmart/community/about/fast-facts.html. Accessed on 29 October 2015.
  7. European Centre for Disease Prevention and Control. Antimicrobial resistance. Available at http://ecdc.europa.eu/en/healthtopics/antimicrobial_resistance/Pages/index.aspx. Accessed on 29 October 2015.
  8. Cars O et al. Variation in antibiotic use in the European Union. Lancet 2001;357(9271):1851-3.
  9. Bronzwaer SLAM et al. A European Study on the Relationship between Antimicrobial Use and Antimicrobial Resistance. Emerg Inf Dis 2002;8(3):278-282.
  10. Goossens H et al. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet 2005;365:579-87.
  11. Seppälä H et al. The effect of changes in the consumption of macrolide antibiotics on erythromycin resistance in group A streptococci in Finland. N Engl J Med 1997;337:441-6.
  12. Stephenson J. Icelandic researchers are showing the way to bring down rates of antibiotic-resistant bacteria. JAMA 1996:275:175.
  13. Lessa FC, Mu Y, Bamberg WM, Beldavs ZG et al. Burden of Clostridium difficile infection in the United States. N Engl J Med 2015;372:825-34.
  14. Davies KA, Longshaw CM, Davis GL et al. Underdiagnosis of Clostridium difficile across Europe: the European, multicenter, prospective, biannual, point-prevalence study of Clostridium difficile infection in hopsitalised patients with diarrhea (EUCLID). Lancet Infect Dis 2014;14:1208-19.
  15. Shehab N, Patel PR, Srinivasan A, Budnitz DS. Emergency department visits for antibiotic-associated adverse events.Clin Infect Dis. 2008 Sep 15;47(6):735-43.
  16. Pepys MB. The acute phase response and C-reactive protein. In: Warrell DA, Cox TM, Firth JD, Benz EJ, eds. Oxford Textbook of Medicine, 4th ed. Oxford University Press, 2003. Vol 2, p.150-156.
  17. Minnaard MC et al. Analytical performance, agreement and user-friendliness of five C-reactive protein point-of-care tests. Scand J Clin Lab Invest. 2013; 73(8): 627–634.
  18. Aabenhus R, Jensen JU, Jørgensen KJ, Hróbjartsson A, Bjerrum L. Biomarkers as point-of-care tests to guide prescription of antibiotics in patients with acute respiratory infections in primary care. Cochrane Database Syst Rev. 2014 Nov 6;11:CD010130.
  19. Cals JWL, Ament AJHA, Hood K, et al. C-reactive protein point of care testing and physician communication skills training for lower respiratory tract infections in general practice: Economic evaluation of a cluster randomized trial. Journal of Evaluation in Clinical Practice. 2011;17(6):1059-1069.
  20. Oppong R, Jit M, Smith RD, et al. Cost-effectiveness of point-of-care C-reactive protein testing to inform antibiotic prescribing decisions. Br J Gen ract 2013;63(612):e465-e471.
  21. Hunter R. Cost-effectiveness of point-of-care C-reactive protein tests for respiratory tract infection in primary care in England. Adv Ther 2015;32(1):69-85
  22. Ylianttila M., Raussi J., QuikRead go, A new point-of-care test system for quantitative determination of C-reactive protein in blood samples. Poster presented at LabMed 2010, XXXII Nordic Congress in Clinical Chemistry, 1-4 June 2010, Oslo, Norway.