C reactive protein-guided prescription of antibiotics for children under 12 years with respiratory symptoms in Kyrgyzstan: protocol for a randomised controlled clinical trial with 14 days follow-up

Overview

In Kyrgyzstan, healthcare providers often prescribe antibiotics when they are unsure of a diagnosis, to avoid potential risks. Using biomarkers like C-reactive protein (CRP) through point-of-care testing (POCT) has been shown to reduce unnecessary antibiotic use, but only few studies have been done in children and no studies exist from Central Asia. This study aims to assess whether the use of a CRP POCT can safely decrease prescription of antibiotics for children with acute respiratory symptoms in primary level healthcare centres in Kyrgyzstan.

Methods

This study is an individually randomized controlled trial with a 14-day follow-up, involving children aged 6 months to 12 years who visit primary care centres with acute respiratory symptoms.

The primary outcomes are:

• The proportion of children prescribed antibiotics within 14 days of the initial consultation: to determine whether CRP testing significantly reduces antibiotic use compared to standard care.
• Time to recovery: to ensure that CRP testing does not result in a clinically relevant delay in recovery.

Secondary outcomes include antibiotic prescription at the initial visit, return visits, hospital admissions, and health status within 14 days. Antibiotic use will be analyzed using an intention-to-treat approach with logistic regression. Recovery time will be assessed using a linear regression model, with a non-inferiority margin of 1 day.