An internet-based training program designed to enhance communication skills in C-reactive protein (CRP) point-of-care testing may be helpful in reducing long-term antibiotic prescribing among general practitioners treating patients with acute uncomplicated lower respiratory tract infections (LRTIs) and upper respiratory tract infections (URTIs), according to study results published in the Annals of Family Medicine.

Researchers included 246 local general practices from 6 different countries that had no history of participation in an antibiotic stewardship program. Patients included in the analysis were adults with LRTI (ie, up to 28 days of cough or based on clinical judgment) or URTI (ie, clinician-judged “other” RTI). General practices were randomly assigned to either usual care (n=61), internet CRP training (n=62), internet communication training (n=61), or a combination of internet CRP/communication training (n=62). The rate of antibiotic prescriptions for respiratory tract infections after 12 months was the primary study outcome.

Approximately 74% of the 228 practices (372 clinicians) that provided 3-month data had 12-month data available for analysis. Antibiotic prescriptions for RTIs decreased from 58% to 51% between 3 and 12 months, respectively, in the usual care group. Increases in prescription rates between 3 months and 12 months were observed in practices randomly assigned to CRP training (35%-43%, respectively; adjusted risk ratio [RR] compared with usual care at 12 months, 0.75; 95% CI, 0.51-1.00; P =.052) and combined interventions (32%-45%, respectively; adjusted RR compared with usual care at 12 months, 0.70; 95% CI, 0.49-0.93; P =.01).

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Compared with usual care, the communication training intervention was effective in reducing antibiotic prescribing rates for LRTIs (RR, 0.71; 95% CI, 0.45-0.99), whereas CRP was not (RR, 0.76; 95% CI, 0.47-1.06). Both communication training (RR, 0.60; 95% CI, 0.37-0.94; P =.02) and CRP (RR, 0.58; 95% CI, 0.36-0.92; P =.02) were effective in reducing prescribing rates for URTIs during the study period.

Limitations of the analysis were the lack of follow-up data for 26% of the practices and the overall short follow-up.

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“Our trial’s findings suggest there is probably only short-term benefit from training clinicians in routine primary care to use CRP,” the researchers wrote. “Instead, the most useful training for long-lasting effects is likely in enhanced communication skills.”


Little P, Stuart B, Francis N, et al; on behalf of the GRACE consortium. Antibiotic prescribing for acute respiratory tract infections 12 months after communication and CRP training: a randomized trial. Ann Fam Med. 2019;17(2):125-132.