Biomarkers as point-of-care tests to guide prescription of antibiotics in people with acute respiratory infections in primary care

• Published in: Cochrane database of systematic reviews 2022-10, Vol.10 (10), p.CD010130
• Main Authors: Smedemark, Siri Aas, Aabenhus, Rune, Llor, Carl, Fournaise, Anders, Olsen, Ole, Jørgensen, Karsten Juhl
• Format: Article
• Language: English
• Subjects: Aged; Anti-Bacterial Agents - therapeutic use; Biomarkers; C-Reactive Protein - analysis; Child; Child health; Humans; Infectious disease; Inflammation; Lungs & airways; Point-of-Care Testing; Prescriptions; Primary Health Care; Procalcitonin - therapeutic use; Randomized Controlled Trials as Topic; Respiratory Tract Infections - diagnosis; Respiratory Tract Infections - drug therapy; Undifferentiated acute respiratory infections
• ISSN: 1469-493X
• DOI: 10.1002/14651858.CD010130.pub3

Acute respiratory infections (ARIs) are by far the most common reason for prescribing an antibiotic in primary care, even though the majority of ARIs are of viral or non-severe bacterial aetiology. It follows that in many cases antibiotic use will not be beneficial to a patient's recovery but may expose them to potential side effects. Furthermore, limiting unnecessary antibiotic use is a key factor in controlling antibiotic resistance. One strategy to reduce antibiotic use in primary care is point-of-care biomarkers. A point-of-care biomarker (test) of inflammation identifies part of the acute phase response to tissue injury regardless of the aetiology (infection, trauma, or inflammation) and may be used as a surrogate marker of infection, potentially assisting the physician in the clinical decision whether to use an antibiotic to treat ARIs. Biomarkers may guide antibiotic prescription by ruling out a serious bacterial infection and help identify patients in whom no benefit from antibiotic treatment can be anticipated. This is an update of a Cochrane Review first published in 2014. To assess the benefits and harms of point-of-care biomarker tests of inflammation to guide antibiotic treatment in people presenting with symptoms of acute respiratory infections in primary care settings regardless of patient age. We searched CENTRAL (2022, Issue 6), MEDLINE (1946 to 14 June 2022), Embase (1974 to 14 June 2022), CINAHL (1981 to 14 June 2022), Web of Science (1955 to 14 June 2022), and LILACS (1982 to 14 June 2022). We also searched three trial registries (10 December 2021) for completed and ongoing trials. We included randomised controlled trials (RCTs) in primary care patients with ARIs that compared the use of point-of-care biomarkers with standard care. We included trials that randomised individual participants, as well as trials that randomised clusters of patients (cluster-RCTs). Two review authors independently extracted data on the following primary outcomes: number of participants given an antibiotic prescription at index consultation and within 28 days follow-up; participant recovery within seven days follow-up; and total mortality within 28 days follow-up. We assessed risk of bias using the Cochrane risk of bias tool and the certainty of the evidence using GRADE. We used random-effects meta-analyses when feasible. We further analysed results with considerable heterogeneity in prespecified subgroups of individual and cluster-RCTs. We included seven new