The Feasibility of C-Reactive Protein Point-of-Care Testing to Reduce Overuse of Antibiotics in Children with Acute Respiratory Tract Infections in Rural Kyrgyzstan: A Pilot Study

Abstract

Background

In Kyrgyzstan, the morbidity prevalence of and morbidity from acute respiratory tract infections (ARTI) in children is high. Local healthcare workers (HCW) often prescribe antibiotics that are not indicative due to a mix of professional and societal factors. It is suggested to precede with a decision on antibiotics by a point-of-care test (POCT) on the appropriateness of the treatment, eg, a measurement of C-reactive protein (CRP). CRP-guided antibiotic stewardship in children with ARTI has not previously been studied in Central Asia.

Purpose

This pilot study was conducted to examine the feasibility of the methods and procedures to be used in the upcoming randomised controlled COORDINATE clinical trial (NCT05195866) and in daily clinical practice in primary care.

Patients and methods

HCWs from three selected rural healthcare facilities were trained in the CRP POCT and in interpretation of results. Children aged 6 months to 12 years attending the primary healthcare facilities with respiratory symptoms were randomly assigned to CRP-guided management or standard care, guided by clinical findings only. Children were followed up for 14 days by scheduled telephone calls to caregivers.

Results

Eighty-one children participated in this pilot study. The CRP POCT and the trial procedures were acceptable to the target group as well as to the HCWs. Children from both groups recovered equally well, with an observed significant lower use of antibiotics in the CRP group. HCWs generally adhered to the CRP guidelines, and only once was an antibiotic prescribed despite low CRP results. No safety concerns were observed. Four parents provided wrong phone numbers impeding follow-up. We will collect all mobile phone numbers in the household for the main trial.

Conclusion

The pilot provided satisfactory results, suggesting that the COORDINATE trial of CRP POCT is effective, feasible with minor adjustments and without apparent safety concerns for the participants.

Keywords:

• paediatrics
• family medicine
• respiratory medicine
• C-reactive protein
• feasibility

Abbreviations

ARTI, Acute respiratory tract infections; ARVI, Acute respiratory viral infections; COVID-19, coronavirus disease 2019; CRF, clinical report form; CRP, C-reactive protein; FMC, family medicine centre; FOP, feldscher-obstetrics point; FPG, family physicians group; HCW, healthcare workers; IMCI, integrated management of childhood illness; ISCRNT, international standard randomised controlled trial number; KAP, knowledge, attitudes and practices; LMIC, low- and middle-income countries; POCT, point-of-care test; RCT, randomised controlled clinical trial; SARS-CoV-2, severe acute respiratory syndrome-related coronavirus 2.

Ethics

The Ethical Committee of the National Centre of Maternity and Childhood Care of the Kyrgyzstan has approved the Study Protocol (Ref. no. 1. Date: 18/06/2021). The study participants are children living in the Kyrgyzstan, who are covered by the protection of citizens of the Kyrgyzstan. The trial will comply fully with all regulatory authorities and will be executed in accordance with Good Clinical Practice. Children in the CRP POCT arm are subjected to a finger prick causing minor transient pain.

Acknowledgments

The authors thank the University of Copenhagen library and authors of the included studies for providing full-text articles. The authors express their deep gratitude to the parents of the children who were sympathetic to the study and with great enthusiasm agreed to the participation of their children, as well as to the participants themselves for their courage and willingness to give their finger for analysis. Special thanks to the RAs, who travelled to rural medical facilities and collected data so carefully and diligently and who did all follow-up calls (Azat Bolotbek uulu, Nargiza Osmonbaeva, Aigerim Tilebalieva, Uuljan Bekbolsunova, Aichurok Alymbekova, Aiperi Muratova, Mohisitora Zhalalova, Zhamilya Zhumadilova).

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This research was funded by the International Centre for Antimicrobial Resistance Solutions (ICARS) (grant number 100008) Copenhagen, Denmark, and Global Health Unit, Department of Paediatrics and Adolescent Health, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.