NICE recommends test to reduce antibiotic use
NICE guidelines say GPs should use point of care blood tests to assess which patients to prescribe antibiotics for bacterial pneumonia in primary care.
In its first guideline on pneumonia, out today, NICE recommends GPs use a blood test for C reactive protein (CRP) “if after clinical assessment a diagnosis of pneumonia has not been made and it is not clear whether antibiotics should be prescribed”.
The CRP test measures levels of inflammation in the body, and can indicate which patients are more likely to have a bacterial pneumonia infection that will respond to antibiotic treatment. Viral chest infections will not respond to antibiotics.
NICE says GPs should use the result of the CRP test to guide their prescribing, only offering antibiotics if the concentration of C-reactive protein is high (>100 milligrammes/litre), delayed antibiotic prescriptions for lower concentrations (20-100 mg/L), and no antibiotics for concentrations lower than 20mg/L.
Last month researchers at the Medical Research Council told Pharmafile that the lack of rapid blood tests in GP surgeries is a key contributor to growing antibiotic resistance in the UK.
Dr Michael Moore, a GP in Southampton and member of the guideline development group, says: “With growing concern over antibiotic resistance, the CRP test is an important tool that can help GPs reduce antibiotic prescribing whilst still being confident about offering patients the best treatment.”
Jonathan Cooke, visiting professor in infectious diseases at Imperial College London, says: “This is a major step forward in the fight against antimicrobial resistance. There is a strong relationship between the use of antibiotics and the development of resistance, and we know that four out of every five prescriptions for antibiotics takes place in primary care.
“A large proportion of these are for respiratory tract infections. There is extensive clinical evidence that CRP testing for patients who present to primary care with respiratory tract infections improves clinical practice and reduces unnecessary antibiotic prescribing by up to 36 per cent.”
A recent survey found antibiotic resistance is a major health concern among the UK general public. The poll of 2,000 people in the UK showed 78% are concerned about antibiotic resistance, and 20% say antibiotic resistance is the greatest health threat to the UK, second only to cancer.
In the UK antibiotic prescribing rates are considerably higher than in other northern European countries – 41.6 million prescriptions were issued in 2013-14 at a cost to the NHS of £192 million.
Around 79% of UK antibiotic prescribing is in primary care, yet few guidelines recommend the use of point of care testing to guide prescribing.
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