LAUSR

Background Antibiotic resistance is a global threat that is both harmful to patients and costly for healthcare services. It is exacerbated by the unnecessary prescription of antibiotics for viral infections. One suggested intervention to help reduce inappropriate prescriptions is point-of-care-testing (POCT) for biomarkers. This systematic review aims to identify the role that POCT for inflammatory biomarkers has in antibiotic prescribing in children. Methods Embase, Medline, Web of Science, Scopus, and Global Health databases were all searched. Studies had to include POCT for biomarkers in children aged 0–18 years. They also had to include antibiotic prescriptions as a measured outcome. A narrative systematic review of the data was then perfomed. Results After duplicates were removed 6461 studies were reviewed. After title and abstract review and full text review 5 papers were included. The study periods were from 2000 to 2015 with 4 of the studies being RCTs and 1 study being a cross sectional study. The intervention of all the studies was CRP POCT with non of the studies looking at white cell count of procalcitonin. Only one paper showed strong evidence that POCT reduced antibiotic prescribing with 64.3% of children in the control group immediately prescribed antibiotics compared with 43.4% in the CRP POCT group (P value<0.0001 and a CI: 0.3 to 0.52). Due to heterogeneity within studies and with a lack of robust high quality RCTs the extent of any association is difficult to quantify. What was seen in the majority of papers is that the context in which POCT is performed appears to be very influential on the outcome be it the country, the ambulatory setting or the doctor performing the test. All papers suggested that POCT was a safe and accepatable test for use in children. Conclusion Based on this review POCT for general biomarkers can not be recommended as a global strategy to improve antibiotic prescribing in children. More high quality research is needed and other biomarkers such as PCT should be researched as well as CRP and WCC. POCT should also be assessed against other antibiotic stewardship interventions and a cost benefit analysis should be performed before any suggest of wider implementation is made.