- CRP testing reduced the percentage of patients prescribed antibiotics at the index visit from 53% in the control group to 31%
- Specific training in communicating about antibiotic appropriateness reduced prescribing from 54% to 27%.
- Combining the two interventions did not increase the benefit over either one alone.
- Antibiotic prescribing remained significantly lower in the CRP-testing group and the enhanced-communication group for at least the observation period—28 days.
- Outcomes and patient satisfaction were similar among groups.
 Cals JWL et al. Effect of point of care testing for C reactive protein and training in communication skills on antibiotic use in lower respiratory tract infections: Cluster randomised trial. BMJ 2009 May 5; 338:b1374. [Medline® Abstract] [Free full-text article]
As an example of the blatant mis- or overuse of antibiotics, we often see many persons are knee-jerked treated with antibiotics for "Sinusitis" that is really a cold/URI.
The article, "Acute bacterial rhino-sinusitis in children: Clinical features and diagnosis" by Ellen R. Wald and Editors with table: "Characteristic features of viral versus bacterial rhinosinusitis in children" is compelling about the difference between conditions. It can be accessed on-line, however one must be registered to UpToDate® [an evidence-based, physician-authored clinical decision support resource] to see it. Here's my take on their table, which is not taking from the original: I'll call it "URI vs a Real Sinus Infection"
|Clinical feature||Viral rhinosinusitis||Bacterial rhinosinusitis|
Usually there is no fever, but when it occurs in the beginning of the illness, it is not a major symptom and it resolves quickly
When you have this condition, the temperature can be quite high, e.g., 102.2°F (≥39°C ) for more than 3 days or it can reoccur at the end of the first week
|Nose discharge:||Coryza, green nasal discharge days 3-6 of the illness; then steadily improves||Worsens|
|Cough||Same as the nose, above||Worsening cough|
|Feeling very bad:||Absent||Definitely feeling bad.|
|Headache:||Usually Absent or minor||Severe headache may be preent early or appear as a complication|
|Course:||Initially may slightly worsen but then improves||Symptoms are a real burden, often lasting over a week and a half|