C-reactive protein testing in primary care and antibiotic use in children with acute respiratory tract infections in Kyrgyzstan: an open-label, individually randomised, controlled trial.

Summary

In a randomized primary care trial (n=1204), point-of-care CRP testing reduced antibiotic prescribing in children with acute respiratory infections by 24 percentage points versus usual care without prolonging recovery or increasing hospitalizations. Reconsultations were modestly higher in the CRP arm.

Key Findings

• CRP testing reduced antibiotic use from 60% to 36% (risk difference 24 percentage points; 95% CI 15–34).
• No difference in time to recovery or hospitalizations between groups; safety preserved.
• Reconsultation rates were modestly higher with CRP testing (OR 1.31; 95% CI 1.01–1.71).

Clinical Implications

Adopting CRP point-of-care testing in pediatric ARTI triage can curb unnecessary antibiotics without compromising safety; systems should prepare for slightly increased reconsultations.

Limitations

• Open-label intervention for clinicians may introduce performance bias
• Conducted in a single country; generalizability to other health systems requires validation

Future Directions

Cost-effectiveness analyses, implementation research on workflow integration and caregiver communication, and multicountry trials to assess generalizability.