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

Study Overview
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Brief Summary
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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.

Official Title
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Impact of the Use of C-reactive Protein in a Micro-method on the Prescription of Antibiotics in General Practitioners Consulting in the Office

Conditions
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Respiratory Infection, Respiratory Infections in Children

Intervention / Treatment
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* Diagnostic Test: Care with C-reactive protein assay in micro method


Participation Criteria
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Eligibility Criteria
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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)

Ages Eligible for Study
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Minimum Age: 3 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Care with C-reactive protein assay in micro method<br>During a visit to the general practitioner for a clinical suspicion of respiratory infection, the doctor will practice a C-reactive protein assay in micro method. He will prescribe antibiotics according to the result of the dosage | Diagnostic Test: Care with C-reactive protein assay in micro method<br>* Care with C-reactive protein assay in micro method<br>|
| No Intervention: Care without C-reactive protein assay in micro method<br>Simple management of a patient coming for a suspicion of respiratory infection without dosage of the C-reactive protein in micro method | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Frequency of antibiotic therapy prescribed | with and without POCT-CRP | 10 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Frequency of antibiotic therapy prescribed in patients aged from 3 to 17 years old | with and without POCT-CRP | 10 days | 
| Frequency of antibiotic therapy prescribed in patients aged from 18 to 64 years old | with and without POCT-CRP | 10 days | 
| Frequency of antibiotic therapy prescribed in patients older than 65 years old | with and without POCT-CRP | 10 days | 
| Type of antibiotic prescribed |  | 10 days | 
| Frequency of complementary exam | with and without POCT-CRP | 10 days | 
| type of complementary exam | with and without POCT-CRP | 10 days | 
| Proportion of number of patients referred to emergency | with and without POCT-CRP | 10 days | 
| Proportion of number of patients with delayed antibiotic therapy | with and without POCT-CRP | 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 | 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 | 10 days | 
| COVID-19 positive patients | Number of COVID-19 positive patients by diagnostic method (From October 2020) | 1 day | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Respiratory Infections, C-reactive protein, antibiotic prescription