BusinessDay

Antibiotics: On-the-spot tests reduce unnecessary prescriptions – says Cochrane research

Fast, on-the-spot tests for bacterial infections may help to reduce excessive antibiotic use, says a systematic review published in The Cochrane Library, which found that when doctors tested for the presence of bacterial infections they prescribed fewer antibiotics.

Antibiotics treat infections caused by bacteria, but not those caused by viruses. Most patients who visit their doctors with acute respiratory infections are suffering from viral infections like the common cold. However, because doctors usually have no immediate way of knowing whether an infection is bacterial or viral, they may still prescribe antibiotics for these patients, the review said.

According to the systematic review, which was made available to BusinessDay by Moriam Chibuzor, Communications Officer at the Nigerian Branch of South African Cochrane Centre (NBofSACC), Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, “Unnecessary use of antibiotics gives bacteria more opportunities to develop resistance to the drugs, meaning that common antibiotics are increasingly powerless in treating serious bacterial infections when they do occur.”

The researcher advised that one way to tackle the problem (of excessive antibiotics use) is to “offer on-the-spot tests that can help doctors to better target antibiotic use in people who have bacterial infections.”

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The researchers looked at evidence from randomised trials on use of the C-reactive protein test, which is currently the only on-the-spot kit available to general practitioners intended to guide antibiotic prescription. It involves testing a single drop of blood collected by pricking the patient’s finger and takes about three minutes.

C-reactive protein acts as a so-called ‘biomarker’of inflammation, and low levels may effectively rule out serious bacterial infection, meaning that use of antibiotics would be unnecessary.

Data on the use of the test was available from six trials involving a total of 3,284 predominantly adult patients. Overall, 631 out of the 1,685 people who took the biomarker test were prescribed antibiotics, compared to 785 out of the 1,599 people who did not take the test.

Antibiotic use was 22% lower in the group who took the test. However, the results varied considerably between studies, possibly due to differences in the way they were designed. This makes interpretation of the findings more difficult.

The NBofSACC said, the review found no difference between the two groups in terms of how long patients took to recover.

“These results suggest that antibiotic use in patients with acute respiratory infections could be reduced by carrying out biomarker tests in addition to routine examinations,” said lead researcher, Rune Aabenhus who is based at the Department of Public Health at the University of Copenhagen in Copenhagen, Denmark.

He said, “Going forward, it would be useful to see more evidence on the size of the reduction and cost-savings, as well as how these tests compare to other antibiotic-saving approaches.”

The Cochrane researchers conclude that the test seems to be safe in its current form. However, in one of the six trials, based on a small number of cases, those who took the biomarker test were more likely to be admitted to hospital at a later date.

“This result may have been a chance finding, but it does remind us that general practitioners need to be careful about how they use these tests” said Aabenhus.

Cochrane is an independent, trusted producer of research into the effects of healthcare treatments and interventions. It said that when trusted evidence is made available to everyone, it can help improve decision-making, reduce treatment costs and drive better health.

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