O'Shea Joseph, Hughes Carmel, Molloy Gerard J, Cadogan Cathal, Vellinga Akke, Fahey Tom, Ryan Cristín
School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
School of Pharmacy, Queen's University Belfast, Belfast, UK.
BMJ Open. 2025 May 27;15(5):e101438. doi: 10.1136/bmjopen-2025-101438.
Antimicrobial resistance is a significant global health challenge, exacerbated by unnecessary antibiotic prescribing. Respiratory tract infections (RTIs) are common reasons for antibiotic prescribing in primary care, despite most being viral or bacterial infections that are self-limiting. C-reactive protein (CRP) point-of-care tests (POCTs) are promising tools to support antibiotic stewardship by guiding the management of lower RTIs (LRTIs). The aim of this study was to develop best practice guidance for using CRP POCT in the management of LRTIs in primary care.
Scoping review findings informed guidance statements, which were then evaluated through a three-round Delphi process with an expert panel via web-based questionnaires. Statements focused on intended use, detection of bacterial LRTIs, communication strategies, device features, performance and ease of use of CRP POCT.
The panel of experts included 19 healthcare professionals across several specialties, including general practitioners, community pharmacists, hospital pharmacists and respiratory physicians.
Panellists rated each guidance statement using a 5-point Likert scale, with acceptance, revision or rejection determined using predefined cut-off scores for medians and interquartile ranges. Statements were revised between rounds using the feedback provided by panellists.
In the first round, 49 statements were evaluated; 16 were accepted, nine removed and 24 revised for the second round. Of the 24 statements evaluated in the second round, 17 were accepted and seven were revised. In the third round, consensus was reached on four of the seven statements presented, resulting in 37 final guidance statements. These statements covered key areas, including the appropriate use of CRP POCTs to guide antibiotic prescribing, CRP cut-off values, integration with clinical decision rules, device performance and operational considerations, training requirements and financial reimbursement. The panel emphasised the need for structured guidelines to align CRP POCT use with clinical context and highlighted its role in improving diagnostic confidence while supporting antibiotic stewardship.
This study provides a set of best practice guidance statements to support the use of CRP POCT in the management of LRTIs in primary care. Dissemination and further research are required to assess their impact.
抗菌药物耐药性是一项重大的全球健康挑战，不必要的抗生素处方加剧了这一问题。呼吸道感染（RTIs）是基层医疗中抗生素处方的常见原因，尽管大多数是病毒或细菌感染，具有自限性。即时检验（POCT）C反应蛋白（CRP）检测是通过指导下呼吸道感染（LRTIs）的管理来支持抗生素管理的有前景的工具。本研究的目的是制定在基层医疗中使用CRP POCT管理LRTIs的最佳实践指南。
范围综述结果为指南声明提供了依据，然后通过三轮德尔菲法，通过基于网络的问卷对一个专家小组进行评估。声明聚焦于CRP POCT的预期用途、细菌性LRTIs的检测、沟通策略、设备特性、性能及易用性。
专家小组包括19名来自多个专业的医疗保健专业人员，包括全科医生、社区药剂师、医院药剂师和呼吸内科医生。
小组成员使用5点李克特量表对每条指南声明进行评分，根据预先定义的中位数和四分位间距的截止分数确定接受、修订或拒绝。各轮之间根据小组成员提供的反馈对声明进行修订。
在第一轮中，评估了49条声明；16条被接受，9条被删除，24条为第二轮进行了修订。在第二轮评估的24条声明中，17条被接受，7条被修订。在第三轮中，对提出的7条声明中的4条达成了共识，产生了37条最终指南声明。这些声明涵盖了关键领域，包括CRP POCT在指导抗生素处方中的适当使用、CRP临界值、与临床决策规则的整合、设备性能和操作考虑、培训要求以及财务报销。小组强调需要有结构化的指南，使CRP POCT的使用与临床情况相匹配，并强调其在提高诊断信心同时支持抗生素管理方面的作用。
本研究提供了一套最佳实践指南声明，以支持CRP POCT在基层医疗中管理LRTIs的应用。需要进行传播和进一步研究以评估其影响。
