Outcomes/Effectiveness Research

C-reactive protein testing is not more effective than an educational intervention to decrease antibiotic prescriptions for patients seen for acute cough

Combining measurement of blood levels of C-reactive protein (CRP) with use of an accepted clinical algorithm on antibiotic treatment of acute cough illness is no better than the clinical algorithm alone in supporting clinicians to not prescribe antibiotics for acute bronchitis, concludes a new study. Despite evidence from numerous studies and subsequent physician education campaigns that routine antibiotic treatment is not generally called for to treat acute cough illness, 50 to 80 percent of adults seen for acute cough are prescribed antibiotics in the absence of coordinated programs to reduce overuse of antibiotics. This over-prescribing of anitbiotics increases the risk of bacteria developing drug resistance.

Blood levels of CRP, an inflammation-associated protein produced by the liver, can help identify bacterial infections in patients. The researchers tested whether combining data from a point-of-care CRP test and an algorithm, which estimates the probability a patient has pneumonia based on the physical examination, would reduce the inappropriate use of antibiotics in patients with acute cough. They randomly assigned 131 patients seeking emergency department (ED) treatment for an acute cough to either an experimental (CRP-plus-algorithm) or control (algorithm only) group. In both groups, the antibiotic prescription rates were substantially lower than previous year levels. The researchers found no significant difference between the two interventions in antibiotic use (37 percent and 31 percent, respectively). The findings were based on 286 patients seen for acute cough at a large, urban ED with an emergency medicine residency program, of whom 131 were eligible and enrolled in the study. The study was funded in part by the Agency for Healthcare Research and Quality (HS13915).

More details are in "C-reactive protein testing does not decrease antibiotic use for acute cough illness when compared with a clinical algorithm," by Ralph Gonzales, M.D., M.S.P.H., Eva A. Aagaard, M.D., Carlos A. Camargo, M.D., Dr.P.H., and others in the July 2011 Journal of Emergency Medicine 41(1), pp. 1-7.

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