Table 3

Studies assessing reduction in antibiotic prescriptions associated with CRP testing in LMICs

StudyCountryAge groupDisease characteristicsNumber of patientsCRP testReduction in antibiotic prescriptionsTargeted prescribing
Studies in South-East Asia
Althaus et al23Thailand and Myanmar≥1 yearFever2410NycoCard Reader (Abott, USA)
  • 290 (36%) of 803 patients for whom a CRP cut-off of 20 mg/L was used to guide prescription and 275 (34%) of 800 for whom a CRP cut-off of 40 mg/L was used were prescribed an antibiotic by day 5, compared with 318 (39%) of 807 patients in whom CRP testing was not performed.

  • The reduction in antibiotic prescriptions up to day 5 in the CRP 20 mg/mL group was non-significant compared with the control group (risk difference –3.3%, 95% CI –8.0 to 1.4; adjusted OR 0.86, 95% CI 0.70 to 1.06).

  • The reduction in antibiotic prescriptions up to day 5 in the CRP 40 mg/mL group was statistically significant (risk difference –5.0%, 95% CI –9.7 to –0.3, adjusted OR 0.80, 95% CI 0.65 to 0.98).

  • Compared with control, a higher proportion of patients with elevated CRP were prescribed an antibiotic in the CRP 20 mg/L group (74% (153/206) vs 48% (103/214), p<0.0001) and the CRP 40 mg/L group (78% (92/118) vs 48% (51/107), p<0.0001).

  • Conversely, a lower proportion of patients with low CRP concentrations, were prescribed an antibiotic in the CRP 20 mg/L group (20% (119/595) vs 30% (134/445), p<0.0001) and the CRP 40 mg/L group (22% (153/682) vs 34% (186/552), p<0.0001).

  • Compared with control more patients in the CRP 20 mg/L (79% vs 63%) and 40 mg/L groups (78% vs 63%) had antibiotics correctly prescribed, assuming those cut-offs were indicative of need for antibiotics.

Do et al24Vietnam1–65 yearsAcute respiratory tract infection2036NycoCard Reader (Abott, USA)
  • The number of patients who used antibiotics within 14 days was 581 (64%) of 902 patients in those in whom CRP testing was performed vs 738 (78%) of 947 patients in the control group, representing a statistically significant reduction (OR 0.49, 95% CI 0.40 to 0.61; p<0.0001).

  • Of patients with immediate antibiotic prescriptions, 75% (758/1017) had CRP measurements of <10 mg/L, 133 (13%) of 10–20 mg/L, 101 (10%) of 21–50 mg/L and 25 (2%) of >50 mg/L.

  • CRP, C reactive protein; LMICs, low-income and middle-income countries.