C-reactive protein testing in patients with acute rhinosinusitis leads to a reduction in antibiotic use

Carl Llor; Lars Bjerrum; Javier Arranz; Guillermo García; Josep Maria Cots; Beatriz González López-Valcárcel; María José Monedero; Manuel Gómez; Jesús Ortega; Gloria Guerra; Marina Cid; José Paredes; Vicenta Pineda; Carolina Pérez; Juan de Dios Alcántara; Silvia Hernández

doi:10.1093/fampra/cms026

C-reactive protein testing in patients with acute rhinosinusitis leads to a reduction in antibiotic use

Carl Llor, Lars Bjerrum, Javier Arranz, Guillermo García, Josep Maria Cots, Beatriz González López-Valcárcel, María José Monedero, Manuel Gómez, Jesús Ortega, Gloria Guerra, Marina Cid, José Paredes, Vicenta Pineda, Carolina Pérez, Juan de Dios Alcántara, Silvia Hernández

17 Citations (Scopus)

Abstract

Objective: To evaluate the effect of C-reactive protein (CRP) testing on the antibiotic prescribing in patients with acute rhinosinusitis. Methods: Audit-based study carried out in primary care centres in Spain. GPs registered episodes of rhinosinusitis during 3-week period before and after an intervention. Two types of intervention were considered: full intervention group (FIG) consisting in individual feedback based on results from the first registry, courses in rational antibiotic prescribing, guidelines, patient information leaflets, workshops on rapid tests and use of the CRP test. GPs in the partial intervention group (PIG) underwent all the above intervention except for the workshop and they did not have access to CRP. Multilevel logistic regression analysis was performed considering the prescription of antibiotics as the dependent variable. Results: Two hundred and ten physicians were assigned to FIG and 71 to PIG. In 2009, 59 new physicians were included as a control group. Two hundred and sixty-seven GPs visited contacts with rhinosinusitis (78.5%) registering a total of 836 cases. In the group of GPs with access to CRP rapid test, 207 patients with rhinosinusitis (75.3%) were tested and antibiotics were prescribed in 156 patients (56.7%). Antibiotics were prescribed in 87 patients (82.9%) in the group of GPs exposed to PIG and in 52 patients (86.7%) in the control group (P < 0.001). Antibiotic prescription was significantly reduced after the intervention among physicians assigned to FIG, with an odds ratio of antibiotic prescribing of 0.12 (95% confidence interval: 0.01-0.32). Conclusion: Physicians with access to CRP tests significantly reduced antibiotic prescription in patients with rhinosinusitis.

Original language	English
Journal	Family Practice
Volume	29
Issue number	6
Pages (from-to)	653-658
Number of pages	6
DOIs	https://doi.org/10.1093/fampra/cms026
Publication status	Published - Dec 2012

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https://academic.oup.com/fampra/article-pdf/29/6/653/1238213/cms026.pdf

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Llor, C., Bjerrum, L., Arranz, J., García, G., Cots, J. M., González López-Valcárcel, B., Monedero, M. J., Gómez, M., Ortega, J., Guerra, G., Cid, M., Paredes, J., Pineda, V., Pérez, C., Alcántara, J. D. D., & Hernández, S. (2012). C-reactive protein testing in patients with acute rhinosinusitis leads to a reduction in antibiotic use. Family Practice, 29(6), 653-658. https://doi.org/10.1093/fampra/cms026

Llor, C, Bjerrum, L, Arranz, J, García, G, Cots, JM, González López-Valcárcel, B, Monedero, MJ, Gómez, M, Ortega, J, Guerra, G, Cid, M, Paredes, J, Pineda, V, Pérez, C, Alcántara, JDD & Hernández, S 2012, 'C-reactive protein testing in patients with acute rhinosinusitis leads to a reduction in antibiotic use', Family Practice, vol. 29, no. 6, pp. 653-658. https://doi.org/10.1093/fampra/cms026

@article{e932aa227528428a9a1a1c03323faf16,

title = "C-reactive protein testing in patients with acute rhinosinusitis leads to a reduction in antibiotic use",

abstract = "Objective: To evaluate the effect of C-reactive protein (CRP) testing on the antibiotic prescribing in patients with acute rhinosinusitis. Methods: Audit-based study carried out in primary care centres in Spain. GPs registered episodes of rhinosinusitis during 3-week period before and after an intervention. Two types of intervention were considered: full intervention group (FIG) consisting in individual feedback based on results from the first registry, courses in rational antibiotic prescribing, guidelines, patient information leaflets, workshops on rapid tests and use of the CRP test. GPs in the partial intervention group (PIG) underwent all the above intervention except for the workshop and they did not have access to CRP. Multilevel logistic regression analysis was performed considering the prescription of antibiotics as the dependent variable. Results: Two hundred and ten physicians were assigned to FIG and 71 to PIG. In 2009, 59 new physicians were included as a control group. Two hundred and sixty-seven GPs visited contacts with rhinosinusitis (78.5%) registering a total of 836 cases. In the group of GPs with access to CRP rapid test, 207 patients with rhinosinusitis (75.3%) were tested and antibiotics were prescribed in 156 patients (56.7%). Antibiotics were prescribed in 87 patients (82.9%) in the group of GPs exposed to PIG and in 52 patients (86.7%) in the control group (P < 0.001). Antibiotic prescription was significantly reduced after the intervention among physicians assigned to FIG, with an odds ratio of antibiotic prescribing of 0.12 (95% confidence interval: 0.01-0.32). Conclusion: Physicians with access to CRP tests significantly reduced antibiotic prescription in patients with rhinosinusitis.",

author = "Carl Llor and Lars Bjerrum and Javier Arranz and Guillermo Garc{\'i}a and Cots, {Josep Maria} and {Gonz{\'a}lez L{\'o}pez-Valc{\'a}rcel}, Beatriz and Monedero, {Mar{\'i}a Jos{\'e}} and Manuel G{\'o}mez and Jes{\'u}s Ortega and Gloria Guerra and Marina Cid and Jos{\'e} Paredes and Vicenta Pineda and Carolina P{\'e}rez and Alc{\'a}ntara, {Juan de Dios} and Silvia Hern{\'a}ndez",

year = "2012",

month = dec,

doi = "10.1093/fampra/cms026",

language = "English",

volume = "29",

pages = "653--658",

journal = "Family Practice",

publisher = "Maclean Hunter Ltd.",

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TY - JOUR

T1 - C-reactive protein testing in patients with acute rhinosinusitis leads to a reduction in antibiotic use

AU - Llor, Carl

AU - Bjerrum, Lars

AU - Arranz, Javier

AU - García, Guillermo

AU - Cots, Josep Maria

AU - González López-Valcárcel, Beatriz

AU - Monedero, María José

AU - Gómez, Manuel

AU - Ortega, Jesús

AU - Guerra, Gloria

AU - Cid, Marina

AU - Paredes, José

AU - Pineda, Vicenta

AU - Pérez, Carolina

AU - Alcántara, Juan de Dios

AU - Hernández, Silvia

PY - 2012/12

Y1 - 2012/12

N2 - Objective: To evaluate the effect of C-reactive protein (CRP) testing on the antibiotic prescribing in patients with acute rhinosinusitis. Methods: Audit-based study carried out in primary care centres in Spain. GPs registered episodes of rhinosinusitis during 3-week period before and after an intervention. Two types of intervention were considered: full intervention group (FIG) consisting in individual feedback based on results from the first registry, courses in rational antibiotic prescribing, guidelines, patient information leaflets, workshops on rapid tests and use of the CRP test. GPs in the partial intervention group (PIG) underwent all the above intervention except for the workshop and they did not have access to CRP. Multilevel logistic regression analysis was performed considering the prescription of antibiotics as the dependent variable. Results: Two hundred and ten physicians were assigned to FIG and 71 to PIG. In 2009, 59 new physicians were included as a control group. Two hundred and sixty-seven GPs visited contacts with rhinosinusitis (78.5%) registering a total of 836 cases. In the group of GPs with access to CRP rapid test, 207 patients with rhinosinusitis (75.3%) were tested and antibiotics were prescribed in 156 patients (56.7%). Antibiotics were prescribed in 87 patients (82.9%) in the group of GPs exposed to PIG and in 52 patients (86.7%) in the control group (P < 0.001). Antibiotic prescription was significantly reduced after the intervention among physicians assigned to FIG, with an odds ratio of antibiotic prescribing of 0.12 (95% confidence interval: 0.01-0.32). Conclusion: Physicians with access to CRP tests significantly reduced antibiotic prescription in patients with rhinosinusitis.

AB - Objective: To evaluate the effect of C-reactive protein (CRP) testing on the antibiotic prescribing in patients with acute rhinosinusitis. Methods: Audit-based study carried out in primary care centres in Spain. GPs registered episodes of rhinosinusitis during 3-week period before and after an intervention. Two types of intervention were considered: full intervention group (FIG) consisting in individual feedback based on results from the first registry, courses in rational antibiotic prescribing, guidelines, patient information leaflets, workshops on rapid tests and use of the CRP test. GPs in the partial intervention group (PIG) underwent all the above intervention except for the workshop and they did not have access to CRP. Multilevel logistic regression analysis was performed considering the prescription of antibiotics as the dependent variable. Results: Two hundred and ten physicians were assigned to FIG and 71 to PIG. In 2009, 59 new physicians were included as a control group. Two hundred and sixty-seven GPs visited contacts with rhinosinusitis (78.5%) registering a total of 836 cases. In the group of GPs with access to CRP rapid test, 207 patients with rhinosinusitis (75.3%) were tested and antibiotics were prescribed in 156 patients (56.7%). Antibiotics were prescribed in 87 patients (82.9%) in the group of GPs exposed to PIG and in 52 patients (86.7%) in the control group (P < 0.001). Antibiotic prescription was significantly reduced after the intervention among physicians assigned to FIG, with an odds ratio of antibiotic prescribing of 0.12 (95% confidence interval: 0.01-0.32). Conclusion: Physicians with access to CRP tests significantly reduced antibiotic prescription in patients with rhinosinusitis.

U2 - 10.1093/fampra/cms026

DO - 10.1093/fampra/cms026

M3 - Journal article

C2 - 22447979

VL - 29

SP - 653

EP - 658

JO - Family Practice

JF - Family Practice

IS - 6

ER -

C-reactive protein testing in patients with acute rhinosinusitis leads to a reduction in antibiotic use

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