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

Overview

In Kyrgyzstan, antimicrobial resistance (AMR) was the third leading cause of death in 2019, driven in large part by the overuse of antibiotics. Among children, acute respiratory tract infections (ARTIs) are the most common reasons for antibiotic prescriptions, despite the majority of these infections being viral and self-limiting. The overuse of antibiotics poses unique challenges in Kyrgyzstan, including limited diagnostic resources in primary care settings, caregiver expectations for antibiotics despite limited clinical indications, and the widespread availability of antibiotics over the counter.

Methods and Findings

This randomized controlled trial involved 1,204 children aged 6 months to 12 years with ARTIs in primary care settings, assigned to receive either standard care or standard care plus C-reactive protein (CRP) testing.

Key findings include:

• Antibiotic Reduction: Antibiotic use was 24 percentage points lower in children who received CRP-guided care (36% vs. 60% in the control group).
• Safety Assured: There was no difference in recovery time or in hospital admissions between the intervention and control groups.
• Scalability Potential: Results suggest that CRP testing is an easily implementable and valuable tool in primary health care that markedly can reduce unnecessary antibiotic use in children with ARTIs.

Conclusion and Implications

The COORDINATE trial revealed that using CRP point-of-care testing in primary healthcare settings significantly reduces antibiotic use in children under 12 years with ARTIs without compromising patient safety. The success of the trial aligns with Kyrgyzstan’s 2022 National Action Plan on AMR and demonstrates how context-specific interventions can drive change. The Ministry of Health of Kyrgyzstan is exploring nationwide implementation of CRP testing based on these findings.