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Antibiotic selection patterns in acutely febrile new outpatients with or without immediate testing for C reactive protein and leucocyte count

¹ Department of Laboratory Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan
² Department of Internal Medicine, Nishi-Ohmiya Hospital, Saitama-City, Saitama 330-0856, Japan
³ Department of Information Technology and Decision Sciences, Yamaguchi University School of Medicine, Ube, Yamaguchi 755-8505, Japan

Correspondence to:
Dr Y Takemura
Department of Laboratory Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan; yutakemu{at}interlink.or.jp Background: Excessive use of broad spectrum antibiotics is related to the spread of drug resistant bacterial strains in the community.

Aim/methods: The effects of immediate testing for C reactive protein (CRP) and white blood cell count (WBC) on physicians’ choices of antibiotic was investigated in patients with acute infection. Acutely febrile new outpatients were randomised into two groups: group 1 (147 patients) underwent CRP and WBC testing before initial consultation (advance testing). Prescriptions were compared with those in group 2 (no advance testing; 154 patients).

Results: In non-pneumonic acute respiratory tract infections, 61 (58%) and 122 (91%) of group 1 and 2 patients were prescribed antibiotics, respectively. Cefcapene pivoxil (third generation cephalosporin) and amoxicillin were the most frequently chosen drugs for group 1 and 2, respectively. Total prescriptions of newer, extended spectrum antibiotics (cefcapene pivoxil and clarithromycin (advanced macrolide)) were reduced by 25% in group 1, although they increased in rate (41 (67%) v 55 (45%) prescriptions) because of the decreased prescription of amoxicillin. In group 1, cefcapene pivoxil was preferentially selected when WBC values were greater than 9 x 10⁹/litre. Prescription shifted to macrolides (mainly clarithromycin) in patients without leucocytosis. Patient treatment outcome did not significantly differ between the two groups.

Conclusions: The availability of CRP and WBC data during initial consultation greatly reduced prescription of amoxicillin, but had a lesser effect on newer, potent, broad spectrum antibiotics.

Abbreviations: CRP, Creactive protein; WBC, white blood cell count

Keywords: acute infection; antibiotic selection; Creactive protein; immediate testing; leucocyte count