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During national health emergencies such as the COVID-19 pandemic, a robust primary care system plays a crucial role in triaging, educating patients and testing [...].During national health emergencies such as the COVID-19 pandemic, a robust primary care system plays a crucial role in triaging, educating patients and testing [...].

In this randomized trial, C-reactive protein testing was used as a point-of-care aid in determining whether antibiotic therapy was warranted in patients with an acute exacerbation of COPD. Among 653 outpatients, there was significantly less use of antibiotics with CRP guidance, with no evidence of any worse outcome.

Abstract Rationale Antimicrobial therapy remains a controversial issue in nonsevere exacerbations of chronic obstructive pulmonary disease (COPD). Objectives To evaluate the efficacy of antibiotic therapy in moderate exacerbations of mild-to-moderate COPD. Methods This study involved a multicenter, parallel, double-blind, placebo-controlled, randomized clinical trial. Patients aged 40 years or older, smokers, or ex-smokers of 10 pack-years or more with spirometrically confirmed mild-to-moderate COPD (FEV1 > 50% predicted and FEV1/FVC ratio < 0.7) and diagnosed with an exacerbation were enrolled in the study. The patients were randomized to receive amoxicillin/clavulanate 500/125 mg three times a day or placebo three times a day for 8 days. Measurements and Main Results The primary outcome measure was clinical cure at end of therapy visit (EOT) at Days 9 to 11. A total of 310 subjects fulfilled all the criteria for efficacy analysis. A total of 117 patients with amoxicillin/clavulanate (74.1%) and 91 with placebo (59.9%) were considered cured at EOT (difference, 14.2%; 95% confidence interval, 3.7–24.3). The median time to the next exacerbation was significantly longer in patients receiving antibiotic compared with placebo (233 d [interquartile range, 110–365] compared with 160 d [interquartile range, 66–365]; P < 0.05). The best C-reactive protein serum cut-off for predicting clinical failure with placebo was 40 mg/L, with an area under the curve of 0.732 (95% confidence interval, 0.614–0.851). Conclusions Treatment of ambulatory exacerbations of mild-to-moderate COPD with amoxicillin/clavulanate is more effective and significantly prolongs the time to the next exacerbation compared with placebo. Clinical trial registered with www.clinical.gov (NCT00495586).

BackgroundRespiratory tract infection tests are increasingly available in primary care and are expected to expand in the future. However, there is limited understanding of clinicians’ views on their benefits and how to effectively integrate them into daily clinical practice.ObjectivesThe aim of this study was to explore healthcare professionals’ views on using respiratory tract infection tests to safely reduce unnecessary antibiotic prescriptions for respiratory tract infections in primary care based on their experience in routine practice.DesignA qualitative study design was employed. Two focus group discussions were conducted.Setting and participantsThese focus group discussions were conducted in February 2025, involving 18 Spanish primary care professionals, both experts and non-experts in rational antibiotic use and antimicrobial resistance. Data were audio-recorded or video-recorded, transcribed and analysed thematically.ResultsParticipants agreed that respiratory tract infection tests help optimise antibiotic prescriptions, reduce uncertainty, ensure the appropriate consumption of resources and guide treatment based on aetiology. While most professionals view microbiological tests and C-reactive protein testing as complementary, non-experts preferred microbiological tests. Professionals considered that patients value knowing the aetiology over the prognosis, supporting shared decision-making and addressing patients’ demands more effectively. Concerns remain about using these tests as stand-alone tools and the medicalisation of self-limiting conditions. Other barriers mentioned included the high cost and time-consuming nature, the need for better professional training and the challenge of managing the increased workload associated with their use.ConclusionsThis study highlights how clinicians perceive respiratory tract infection tests to aid prescribing decisions amid uncertainty. Both positive and negative views were reported. Participants agreed that these tests optimise antibiotic prescriptions and guide treatment, but there are still important barriers to their implementation.

High-volume prescribing of antibiotics in primary care is a major driver of antibiotic resistance. Education of physicians and patients can lower prescribing levels, but it frequently relies on highly trained staff. We assessed whether internet-based training methods could alter prescribing practices in multiple health-care systems. After a baseline audit in October to December, 2010, primary-care practices in six European countries were cluster randomised to usual care, training in the use of a C-reactive protein (CRP) test at point of care, in enhanced communication skills, or in both CRP and enhanced communication. Patients were recruited from February to May, 2011. This trial is registered, number ISRCTN99871214. The baseline audit, done in 259 practices, provided data for 6771 patients with lower-respiratory-tract infections (3742 [55·3%]) and upper-respiratory-tract infections (1416 [20·9%]), of whom 5355 (79·1%) were prescribed antibiotics. After randomisation, 246 practices were included and 4264 patients were recruited. The antibiotic prescribing rate was lower with CRP training than without (33% vs 48%, adjusted risk ratio 0·54, 95% CI 0·42–0·69) and with enhanced-communication training than without (36% vs 45%, 0·69, 0·54–0·87). The combined intervention was associated with the greatest reduction in prescribing rate (CRP risk ratio 0·53, 95% CI 0·36–0·74, p<0·0001; enhanced communication 0·68, 0·50–0·89, p=0·003; combined 0·38, 0·25–0·55, p<0·0001). Internet training achieved important reductions in antibiotic prescribing for respiratory-tract infections across language and cultural boundaries. European Commission Framework Programme 6, National Institute for Health Research, Research Foundation Flanders.

Antimicrobial resistance (AMR) continues to be a global problem and continues to be addressed through national strategies to improve diagnostics, develop new antimicrobials and promote antimicrobial stewardship. Patients who attend general (ambulatory) practice with symptoms of respiratory tract infections (RTIs) are invariably assessed by some sort of clinical decision rule (CDR). However, CDRs rely on a cluster of non-specific clinical observations. A narrative review of the literature was undertaken to ascertain the value of C reactive protein (CRP) point-of-care testing (POCT) to guide antibacterial prescribing in adult patients presenting to general practitioner (GP) practices with symptoms of RTI. Studies that were included were Cochrane reviews, systematic reviews, randomised controlled trials, cluster randomised trials, controlled before and after studies, cohort studies and economic evaluations. An overwhelming number of studies demonstrated that the use of CRP tests in patients presenting with RTI symptoms reduces index antibacterial prescribing. GPs and patients report a good acceptability for a CRP POCT and economic evaluations show cost-effectiveness of CRP POCT over existing RTI management in primary care. POCTs increase diagnostic precision for GPs in the better management of patients with RTI. With the rapid development of artificial intelligence, patients will expect greater precision in diagnosing and managing their illnesses. Adopting systems that markedly reduce antibiotic consumption is a no-brainer for governments that are struggling to address the rise in AMR.

Urinary tract infections (UTIs) are a frequent consultation in primary care and are usually treated with empirical antibiotics. Women suffer more from UTIs than men, and are therefore more likely to be treated with antibiotics. The aim of this study was to describe the epidemiology of UTIs in women in Catalonia, Spain. We conducted a population-based observational cohort study that included women patients diagnosed with UTI and recurrent UTI within the SIDIAP and CMBD database during the period from 2012 to 2021. UTI diagnoses were grouped into two main groups, cystitis and pyelonephritis, and patients recorded as having 2 or more episodes of UTI within the year following the first recorded UTI were considered to have recurrent UTI. The study identified 962,998 women with at least one UTI episode. Cystitis was the most frequently reported infection and was primarily treated with fosfomycin, aligning with local clinical guidelines. Pyelonephritis was typically managed with penicillins. Recurrent UTIs accounted for 3.7% of the sample. This large-scale cohort study provides a comprehensive overview of the epidemiology, management, and treatment of urinary tract infections in women in Catalonia. The findings highlight the widespread use of guideline-recommended antibiotics in the routine clinical management of cystitis, but not of pyelonephritis, and underscore the burden of recurrent infections in a small yet clinically significant subgroup of patients.