Impact of the Use of CRP on the Prescription of Antibiotics in General Practitioners

Centre Hospitalier Intercommunal Creteil406 enrolled

Overview

Respiratory infections, including episodes of coughing with fever, are the main cause of outpatient antibiotic prescription, while a minority of them are linked to bacterial infections requiring antibiotic. These prescriptions are often performed by general practitioners. These unnecessary antibiotic contribute to increased bacterial resistance, side effects and unnecessary costs. Campaigns for the correct prescription of antibiotics have had a real but partial or transient success. C-reactive protein micro-method (POCT-CRP) could help to differentiate between viral and bacterial infections and thus contribute to the proper use of antibiotics. The decrease in prescription of antibiotics is likely to have an even stronger positive impact in countries like France, where prescription is high. The objective of this study is to evaluate the use of POCT-CRP in the general practitioner's office in case of suspected respiratory infection.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

DIAGNOSTIC

Masking

NONE

Enrollment

406

Conditions

Respiratory Infection Respiratory Infections in Children

Interventions

Eligibility

Sex: ALLMin age: 3 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age ≥ 3 years * Clinical suspicion of respiratory infection defined by the presence of at least one respiratory sign among, cough, dyspnea, chest pain and auscultatory abnormality and at least one general sign among fever, sweat, headache, myalgia, impairment of general condition * Affiliated to a social health insurance * Signed consent Exclusion Criteria: * Duration of symptoms \< 24 hours * Hospitalization or emergency assessment decision decided from the outset * Signs of severity before the realization of POCT-CRP * Patient previously included in the study for the same episode * Antibiotic therapy within 7 days * Chronic cough (more than 3 weeks)

Locations (14)

22 rue de Silly

Boulogne, France

18 rue Sainte Bathilde

Chelles, France

25 avenue des frères Lumière

Cormeilles-en-Parisis, France

8 Rue Saint-Exupéry

Meudon-la-Forêt, France

258 Bis Rue de Paris

Montreuil, France

61bis Boulevard de Charonne

Paris, France

25 Rue de Fécamp

Paris, France

237 Rue de la Croix Nivert,

Paris, France

1 Rue Colette Magny

Paris, France

391 Rue des Pyrénées

Paris, France

...and 4 more locations

Outcomes

Primary Outcomes

Frequency of antibiotic therapy prescribed

with and without POCT-CRP

Time frame: 10 days

Secondary Outcomes

Frequency of antibiotic therapy prescribed in patients aged from 3 to 17 years old

with and without POCT-CRP

Time frame: 10 days

Frequency of antibiotic therapy prescribed in patients aged from 18 to 64 years old

with and without POCT-CRP

Time frame: 10 days

Frequency of antibiotic therapy prescribed in patients older than 65 years old

with and without POCT-CRP

Time frame: 10 days

Type of antibiotic prescribed

Time frame: 10 days

Frequency of complementary exam

with and without POCT-CRP

Time frame: 10 days

type of complementary exam

with and without POCT-CRP

Time frame: 10 days

Proportion of number of patients referred to emergency

with and without POCT-CRP

Time frame: 10 days

Proportion of number of patients with delayed antibiotic therapy

with and without POCT-CRP

Time frame: 10 days

number of prescription following the recommended algorythms

Adequacy between the proposed decision algorithm according to the C-reactive protein assay and the antibiotic prescription

Time frame: 10 days

Concordance between the prescription proposed by the decision algorithm as a function of the micro-CRP and the prescription realized: kappa coefficient

The assessment of the utility of the POCT procedure

Time frame: 10 days

COVID-19 positive patients

Number of COVID-19 positive patients by diagnostic method (From October 2020)

Time frame: 1 day