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

Not Applicable

Completed

• Conditions: Respiratory Infection; Respiratory Infections in Children
• Interventions: Diagnostic Test: Care with C-reactive protein assay in micro method

• Registration Number: NCT03540706
• Lead Sponsor: Centre Hospitalier Intercommunal Creteil

Brief Summary

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.

Detailed Description

Not available

Study Timeline

• Study Start: 2018-05-01
• Study First Submitted: 2018-05-17
• Study First Submitted QC: 2018-05-17
• Study First Posted: 2018-05-30
• Primary Completion: 2023-03-13
• Study Completion: 2023-03-13
• Status Verified: 2023-08
• Last Update Submitted: 2023-08-04
• Last Update Posted: 2023-08-07

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 406

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)

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Care with C-reactive protein assay in micro method	Care with C-reactive protein assay in micro method	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

Primary Outcome Measures

Name	Time	Method
Frequency of antibiotic therapy prescribed	10 days	with and without POCT-CRP

Secondary Outcome Measures

Name	Time	Method
Frequency of complementary exam	10 days	with and without POCT-CRP
type of complementary exam	10 days	with and without POCT-CRP
Proportion of number of patients with delayed antibiotic therapy	10 days	with and without POCT-CRP
COVID-19 positive patients	1 day	Number of COVID-19 positive patients by diagnostic method (From October 2020)
Frequency of antibiotic therapy prescribed in patients aged from 18 to 64 years old	10 days	with and without POCT-CRP
number of prescription following the recommended algorythms	10 days	Adequacy between the proposed decision algorithm according to the C-reactive protein assay and the antibiotic prescription
Frequency of antibiotic therapy prescribed in patients aged from 3 to 17 years old	10 days	with and without POCT-CRP
Frequency of antibiotic therapy prescribed in patients older than 65 years old	10 days	with and without POCT-CRP
Proportion of number of patients referred to emergency	10 days	with and without POCT-CRP
Concordance between the prescription proposed by the decision algorithm as a function of the micro-CRP and the prescription realized: kappa coefficient	10 days	The assessment of the utility of the POCT procedure
Type of antibiotic prescribed	10 days

Trial Locations

Locations (14)

258 Bis Rue de Paris; 🇫🇷 Montreuil, France

237 Rue de la Croix Nivert,; 🇫🇷 Paris, France

1 Rue Colette Magny; 🇫🇷 Paris, France

391 Rue des Pyrénées; 🇫🇷 Paris, France

22 rue de Silly; 🇫🇷 Boulogne, France

18 rue Sainte Bathilde; 🇫🇷 Chelles, France

25 Rue de Fécamp; 🇫🇷 Paris, France

61bis Boulevard de Charonne; 🇫🇷 Paris, France

50 Rue de la Justice; 🇫🇷 Paris, France

20 avenue Gorges Sand; 🇫🇷 Stains, France

19 Rue du Midi; 🇫🇷 Vincennes, France

72 Boulevard Davout; 🇫🇷 Paris, France

25 avenue des frères Lumière; 🇫🇷 Cormeilles-en-Parisis, France

8 Rue Saint-Exupéry; 🇫🇷 Meudon La Forêt, France