Does availability of point of care C-reactive protein measurement affect provision of antibiotics in a community respiratory service?
Antibiotic resistance presents a growing threat to health systems and patients at a global scale. Point of care (POC) C-reactive protein (CRP) measurement, as an adjunct to exacerbation assessment, has been studied in primary and secondary care and may represent a useful tool for community teams. A retrospective service review was conducted to determine the effect of CRP measurement on antibiotic provision in a community respiratory setting, with chronic obstructive pulmonary disease (COPD) and bronchiectasis exacerbations. This review compared antibiotic provision for COPD and bronchiectasis patients for those where CRP was measured versus those where it was not. It was found that antibiotic provision dropped by almost 25% points for COPD exacerbations, and almost 59% in bronchiectasis, when a CRP measurement was taken as a component of a respiratory assessment. Antibiotics were also provided at a greater amount based on symptom presentation. Therefore, it is concluded that CRP measurement correlates with a reduction in antibiotic provision, highlighting its use alongside symptom assessment in future work.
Resistance to antibiotics is an escalating concern, both worldwide and locally. Data from Public Health England's (PHE) 2020 English Surveillance Programme places the number of severe resistant infections at 65 162 in 2019 (equating to 178 daily new antibiotic-resistant infections a day), an increase of 7.2% from the previous year, which was a further 9% increase from the year preceding that. Across the world, mortality associated with antibiotic resistance is predicted to continue to rise (European Medicines Agency, 2009), with some estimates of costs in losses to productivity globally amounting to tens of trillions of pounds (PHE, 2015).
Between 2015-2019, antibiotic prescribing within general practice in England has declined by around 12%; however, antibiotic prescribing in community settings has increased by almost 29% over the same period when comparing defined daily doses per 1000 inhabitants per day (an estimate of the daily population proportion receiving antibiotics (World Health Organization, 2021). This is a large increase, although general practice prescribing currently accounts for 71% of all prescribing, compared to 4% within other community settings (PHE, 2020).
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