Dr Rogier Hopstaken | A Simple Point-of-Care Test to Combat Antibiotic Resistance

One contributing factor to antibiotic resistance is the extensive over-prescription of antibiotics to patients, particularly for respiratory infections. However, 70–80% of these infections are not severe and are often viral, and should not be treated with antibiotics. Those patients will recover without treatment – and may even be harmed by antibiotics.

Dr Rogier Hopstaken, a general practitioner and researcher from the Netherlands, has shown that a simple yet effective technique may be the answer to antibiotic over-prescription. This technique is called C-reactive protein point-of-care testing, which assesses blood levels of a protein produced by the liver in response to inflammation.

This test can be used in primary care settings, such as a physician’s clinic, to indicate within 3 minutes whether a patient with a respiratory illness has a severe bacterial infection and requires antibiotics.

Dr Hopstaken and his team have shown that C-reactive protein is by far the best predictor of pneumonia, performing much better than any symptom or sign, and better than the combination of all symptoms and signs.

In two studies involving patients with respiratory infections, his team demonstrated that the use of this test led to a 30% reduction in unnecessary antibiotic prescriptions. Improving communication skills added considerably to this effect.

Dr Hopstaken wants to improve the diagnostic and communication skills of physicians, so that more patients with pneumonia get the antibiotics they need, while antibiotics can be safely withheld from those with minor illnesses. To achieve this, he argues that a support model must also be created for physicians to facilitate integration and to ensure the quality of testing. Finally, he believes that funding for the test equipment should be seen as a wider investment in better, cost-effective healthcare.

Although C-reactive protein point-of-care testing and better communication will play an important role in reducing antibiotic resistance, it should be seen as one intervention in a multi-step process. Dr Hopstaken has shown that this type of antibiotic stewardship could pave the way to finally addressing antibiotic resistance, starting with primary care where most antibiotics are prescribed, and then beyond.