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 trialResearch in context
Summary: Background: Addressing the global antibacterial resistance crisis and aligning with the Kyrgyz Ministry of Health’s research priorities, this study assesses the efficacy and safety of C-reactive protein (CRP) testing to guide antibiotic prescriptions in children with acute respiratory trac...
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Elsevier
2025-04-01
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| Series: | The Lancet Regional Health. Europe |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666776224003533 |
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| author | Elvira Isaeva Joakim Bloch Azamat Akylbekov Robert L. Skov Anja Poulsen Jørgen A.L. Kurtzhals Susanne Reventlow Nandini Sreenivasan Maamed Mademilov Volkert D. Siersma Talant Sooronbaev Jesper Kjærgaard Rune M. Aabenhus |
| author_facet | Elvira Isaeva Joakim Bloch Azamat Akylbekov Robert L. Skov Anja Poulsen Jørgen A.L. Kurtzhals Susanne Reventlow Nandini Sreenivasan Maamed Mademilov Volkert D. Siersma Talant Sooronbaev Jesper Kjærgaard Rune M. Aabenhus |
| author_sort | Elvira Isaeva |
| collection | DOAJ |
| description | Summary: Background: Addressing the global antibacterial resistance crisis and aligning with the Kyrgyz Ministry of Health’s research priorities, this study assesses the efficacy and safety of C-reactive protein (CRP) testing to guide antibiotic prescriptions in children with acute respiratory tract infections (ARTI) in Kyrgyzstan. Methods: In this open label individually randomised controlled trial, children aged 6 months to 12 years with ARTI in primary care settings were assigned to receive either standard care or standard care plus CRP testing. The study measured two primary outcomes: total antibiotic usage over a 14-day follow-up and caregiver-reported time to recovery. Follow-up assessments (days 3, 7, 14) were blinded. Trial registration: NCT05195866. Findings: A total of 1204 patients were randomised. Antibiotic use was lower in the CRP group (216/601, 36%) compared to the control group (362/603, 60%; Risk difference: 24 percentage points; 95% confidence interval (CI): 15–34). There was no significant difference in time to recovery (log-rank test p = 0.090) and the prespecified non-inferiority margin of one day was not exceeded. Hospital admissions were similar in both groups (CRP: 31 (5%), control: 26 (4%); odds ratio (OR) 1.20, 95% CI 0.69–2.10), but the CRP group re-consulted more often (OR 1.31, 95% CI 1.01–1.71) during the 14 days of follow-up. Interpretation: Implementing CRP testing in primary care for paediatric ARTI in Kyrgyzstan significantly reduced antibiotic use without negative effects on safety, supporting its role in national antimicrobial stewardship strategies. Funding: International Centre for Antimicrobial Resistance Solutions (ICARS). |
| format | Article |
| id | doaj-art-42d015cc414c49748ea4f707ac66aa95 |
| institution | Kabale University |
| issn | 2666-7762 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Regional Health. Europe |
| spelling | doaj-art-42d015cc414c49748ea4f707ac66aa952025-01-11T06:42:06ZengElsevierThe Lancet Regional Health. Europe2666-77622025-04-0151101184C-reactive protein testing in primary care and antibiotic use in children with acute respiratory tract infections in Kyrgyzstan: an open-label, individually randomised, controlled trialResearch in contextElvira Isaeva0Joakim Bloch1Azamat Akylbekov2Robert L. Skov3Anja Poulsen4Jørgen A.L. Kurtzhals5Susanne Reventlow6Nandini Sreenivasan7Maamed Mademilov8Volkert D. Siersma9Talant Sooronbaev10Jesper Kjærgaard11Rune M. Aabenhus12National Centre of Maternity and Childhood Care (NCMCC), Bishkek, Kyrgyzstan; The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, DenmarkDepartment of Paediatrics and Adolescent Medicine, Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkNational Centre of Cardiology and Internal Medicine Named After Academician M. Mirrakhimov, Bishkek, KyrgyzstanInternational Centre for Antimicrobial Resistance Solutions, Copenhagen, DenmarkDepartment of Paediatrics and Adolescent Medicine, Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Centre for Translational Medicine and Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, DenmarkThe Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, DenmarkInternational Centre for Antimicrobial Resistance Solutions, Copenhagen, DenmarkNational Centre of Cardiology and Internal Medicine Named After Academician M. Mirrakhimov, Bishkek, KyrgyzstanThe Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, DenmarkNational Centre of Cardiology and Internal Medicine Named After Academician M. Mirrakhimov, Bishkek, Kyrgyzstan; Corresponding author.Department of Paediatrics and Adolescent Medicine, Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkThe Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, DenmarkSummary: Background: Addressing the global antibacterial resistance crisis and aligning with the Kyrgyz Ministry of Health’s research priorities, this study assesses the efficacy and safety of C-reactive protein (CRP) testing to guide antibiotic prescriptions in children with acute respiratory tract infections (ARTI) in Kyrgyzstan. Methods: In this open label individually randomised controlled trial, children aged 6 months to 12 years with ARTI in primary care settings were assigned to receive either standard care or standard care plus CRP testing. The study measured two primary outcomes: total antibiotic usage over a 14-day follow-up and caregiver-reported time to recovery. Follow-up assessments (days 3, 7, 14) were blinded. Trial registration: NCT05195866. Findings: A total of 1204 patients were randomised. Antibiotic use was lower in the CRP group (216/601, 36%) compared to the control group (362/603, 60%; Risk difference: 24 percentage points; 95% confidence interval (CI): 15–34). There was no significant difference in time to recovery (log-rank test p = 0.090) and the prespecified non-inferiority margin of one day was not exceeded. Hospital admissions were similar in both groups (CRP: 31 (5%), control: 26 (4%); odds ratio (OR) 1.20, 95% CI 0.69–2.10), but the CRP group re-consulted more often (OR 1.31, 95% CI 1.01–1.71) during the 14 days of follow-up. Interpretation: Implementing CRP testing in primary care for paediatric ARTI in Kyrgyzstan significantly reduced antibiotic use without negative effects on safety, supporting its role in national antimicrobial stewardship strategies. Funding: International Centre for Antimicrobial Resistance Solutions (ICARS).http://www.sciencedirect.com/science/article/pii/S2666776224003533PaediatricsCRP POCTAcute respiratory infectionsChildrenPrimary healthcareFever |
| spellingShingle | Elvira Isaeva Joakim Bloch Azamat Akylbekov Robert L. Skov Anja Poulsen Jørgen A.L. Kurtzhals Susanne Reventlow Nandini Sreenivasan Maamed Mademilov Volkert D. Siersma Talant Sooronbaev Jesper Kjærgaard Rune M. Aabenhus 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 trialResearch in context The Lancet Regional Health. Europe Paediatrics CRP POCT Acute respiratory infections Children Primary healthcare Fever |
| title | 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 trialResearch in context |
| title_full | 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 trialResearch in context |
| title_fullStr | 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 trialResearch in context |
| title_full_unstemmed | 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 trialResearch in context |
| title_short | 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 trialResearch in context |
| title_sort | 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 trialresearch in context |
| topic | Paediatrics CRP POCT Acute respiratory infections Children Primary healthcare Fever |
| url | http://www.sciencedirect.com/science/article/pii/S2666776224003533 |
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