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Reducing Antibiotic Use for Lower Respiratory Tract Infections

Communication skills training and use of bedside C-reactive protein testing reduce antibiotic prescribing for lower respiratory tract infections without affecting patient outcomes.

Antibiotics frequently are prescribed unnecessarily for patients with nonspecific lower respiratory tract infections despite overwhelming evidence against the practice. In a cluster-randomized controlled trial, researchers assessed the effects of enhanced physician–patient communication skills training (tailored to address patients’ concerns about the need for antibiotics) and use of point-of-care C-reactive protein (CRP) testing on antibiotic prescribing for adult patients with lower respiratory tract infections. Forty general practitioners at 20 general practices in the Netherlands were allocated to communications skills training (84 patients), CRP testing (110 patients), both interventions (117 patients), or usual care (control group; 120 patients).

Use of point-of-care CRP testing reduced the percentage of patients who were prescribed antibiotics at the index visit from 53% in the control group to 31%; similarly, training in enhanced communication skills reduced prescribing from 54% to 27%. Combining the two interventions did not increase the benefit over either one alone. During 28 days of follow-up, antibiotic prescribing remained significantly lower in the CRP-testing group and the enhanced-communication group. Outcomes and patient satisfaction were similar among groups.

Comment: Using evidence-based practice to restrict antibiotic prescriptions to patients who are likely to benefit from them will decrease local antibiotic resistance as well as global emergence of resistant bacterial strains. Good communication makes sense. We should continue to educate patients that most lower respiratory tract infections improve without antibiotic therapy. However, if you suspect pneumonia, forget bedside CRP testing and get a chest x-ray!

— Kristi L. Koenig, MD, FACEP

Published in Journal Watch Emergency Medicine May 22, 2009

Citation(s):

Cals JWL et al. Effect of point of care testing for C reactive protein and training in communication skills on antibiotic use in lower respiratory tract infections: Cluster randomised trial. BMJ 2009 May 5; 338:b1374. (http://dx.doi.org/10.1136/bmj.b1374)

• Original article (Subscription may be required)
• Medline abstract (Free)

Hay AD and Jüttner KV. Antibiotics for acute cough in primary care. BMJ 2009 May 5; 338:b834. (http://dx.doi.org/10.1136/bmj.b834)

• Original article (Subscription may be required)
• Medline abstract (Free)