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      Respiratory tract infections (RTIs) in primary care: narrative review of C reactive protein (CRP) point-of-care testing (POCT) and antibacterial use in patients who present with symptoms of RTI

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          Abstract

          Antimicrobial resistance (AMR) continues to be a global problem and continues to be addressed through national strategies to improve diagnostics, develop new antimicrobials and promote antimicrobial stewardship. Patients who attend general (ambulatory) practice with symptoms of respiratory tract infections (RTIs) are invariably assessed by some sort of clinical decision rule (CDR). However, CDRs rely on a cluster of non-specific clinical observations. A narrative review of the literature was undertaken to ascertain the value of C reactive protein (CRP) point-of-care testing (POCT) to guide antibacterial prescribing in adult patients presenting to general practitioner (GP) practices with symptoms of RTI. Studies that were included were Cochrane reviews, systematic reviews, randomised controlled trials, cluster randomised trials, controlled before and after studies, cohort studies and economic evaluations. An overwhelming number of studies demonstrated that the use of CRP tests in patients presenting with RTI symptoms reduces index antibacterial prescribing. GPs and patients report a good acceptability for a CRP POCT and economic evaluations show cost-effectiveness of CRP POCT over existing RTI management in primary care. POCTs increase diagnostic precision for GPs in the better management of patients with RTI. With the rapid development of artificial intelligence, patients will expect greater precision in diagnosing and managing their illnesses. Adopting systems that markedly reduce antibiotic consumption is a no-brainer for governments that are struggling to address the rise in AMR.

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          Literature review as a research methodology: An overview and guidelines

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            The Diagnosis of Strep Throat in Adults in the Emergency Room

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              C-Reactive Protein Testing to Guide Antibiotic Prescribing for COPD Exacerbations

              Point-of-care testing of C-reactive protein (CRP) may be a way to reduce unnecessary use of antibiotics without harming patients who have acute exacerbations of chronic obstructive pulmonary disease (COPD).
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                Author and article information

                Journal
                BMJ Open Respir Res
                BMJ Open Respir Res
                bmjresp
                bmjopenrespres
                BMJ Open Respiratory Research
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2052-4439
                2020
                6 September 2020
                : 7
                : 1
                : e000624
                Affiliations
                [1 ]departmentDepartment of Surgery and Cancer, Faculty of Medicine , Imperial College , London, United Kingdom
                [2 ]departmentFaculty of Medical and Human Sciences , University of Manchester , Manchester, UK
                [3 ]departmentPrimary Care , University Institute in Primary Care Research Jordi Gol , Barcelona, Spain
                [4 ]Star-shl diagnostic centers , Etten-Leur, The Netherlands
                [5 ]departmentDepartment of Microbiology , Hampshire Hospitals NHS Foundation Trust , Winchester, UK
                [6 ]departmentThe Nuffield Department of Primary Care Health Sciences , University of Oxford , Oxford, Oxfordshire, UK
                Author notes
                [Correspondence to ] Professor Jonathan Cooke; j.cooke@ 123456imperial.ac.uk
                Author information
                http://orcid.org/0000-0001-5016-9048
                Article
                bmjresp-2020-000624
                10.1136/bmjresp-2020-000624
                7476490
                32895246
                d84c0b6d-255c-4ea2-96f6-7e933aaa404a
                © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 28 April 2020
                : 28 July 2020
                : 30 July 2020
                Categories
                Respiratory Infection
                1506
                2229
                Custom metadata
                unlocked

                bacterial infection,respiratory infection
                bacterial infection, respiratory infection

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