Antibiotic overuse in lower respiratory tract infections (LRTIs) remains a major driver of antimicrobial resistance (AMR), particularly in European primary care settings. Evidence suggests that C-reactive protein (CRP) point-of-care testing (POCT), when combined with effective communication strategies and supportive health policies, can significantly reduce unnecessary antibiotic prescribing.

Background: Antibiotic Overuse in LRTIs

In Europe, antibiotic prescriptions for LRTIs are estimated to be two to three times higher than clinically necessary. Diagnostic uncertainty often leads to empirical antibiotic use, highlighting the need for objective biomarkers to improve diagnostic precision and prescribing decisions.

Clinical Workflow for CRP-Guided Management

A structured CRP-based clinical workflow supports rational antibiotic use:

• Patients presenting with LRTI symptoms undergo initial clinical assessment followed by CRP POCT.

• CRP < 20 mg/L: Antibiotics are discouraged; patient education and observation are recommended.

• CRP 20–100 mg/L: Delayed prescribing may be considered through shared decision-making.

• CRP > 100 mg/L: Antibiotic treatment is initiated.

Test results can also inform future updates to local guidelines and antibiotic strategies.

Real-World Impact Across European Countries

Implementation outcomes vary across countries depending on reimbursement policies and guideline integration:

• Netherlands: Full reimbursement and mandatory guideline integration resulted in approximately 40% reduction in antibiotic prescriptions.

• Switzerland: Partial reimbursement combined with testing and patient education led to a 35% reduction.

• Spain: Limited coverage and reliance on clinical judgment alone resulted in a smaller reduction of around 10%.

Conclusion

CRP POCT is an effective and accessible tool to reduce unnecessary antibiotic use in primary care. When supported by appropriate reimbursement policies, guideline integration, and clinician education, CRP testing plays a meaningful role in combating antimicrobial resistance.

Reference:
doi: 10.3390/diagnostics13020320