Table 5

Overview of the good and the bad

‘The good’ (advantages)‘The bad’ (disadvantages)
Viability as a marker of bacterial infection
  • Correlation between elevated CRP levels and presence of bacterial infection is consistent across studies.

  • CRP levels are also elevated in patients with malaria, hence identifying malaria/bacterial co-infections is challenging.

  • CRP performance (AUROC, sensitivities and specificities) is variable across studies.

  • A universally applicable cut-off point is difficult to determine.

Impact on antibiotic prescribing
  • Studies show a reduction in overall number of antibiotic prescriptions with CRP testing.

  • Reductions in antibiotic prescriptions were only significant at higher cut-off.

  • Number of studies is limited.

Cost-effectiveness
  • CRP testing is cost-effective when test results are adhered to.

  • Adherence to CRP test results has been variable in studies assessing impact on antibiotic prescription.

  • Number of cost-effectiveness studies in low-resource settings is limited.

  • CRP, C reactive protein.