COORDINATE
Trial question
What is the role of CRP testing to guide antibiotic prescriptions in children with acute respiratory tract infections?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
48.0% female
52.0% male
N = 1204
1204 patients (579 female, 625 male).
Inclusion criteria: children aged 6-12 months with acute respiratory tract infections.
Key exclusion criteria: severe illness; need for hospitalization; antibiotics within 24 hours.
Interventions
N=601 CRP testing (CRP point-of-care testing plus usual care).
N=603 usual care (usual care only).
Primary outcome
Rate of antibiotic use over a 14-day follow-up
35.9%
60%
60.0 %
45.0 %
30.0 %
15.0 %
0.0 %
C-reactive protein
testing
Usual
care
Significant
decrease ▼
NNT = 4
Significant decrease in the rate of antibiotic use over a 14-day follow-up (35.9% vs. 60%; OR 0.37, 95% CI 0.25 to 0.54).
Secondary outcomes
Significant increase in immunomodulator treatment at 14 days (35.8% vs. 30.2%; OR 1.29, 95% CI 1.05 to 1.58).
Significant increase in re-consultations at 14 days (21.3% vs. 17.1%; OR 1.31, 95% CI 1.01 to 1.71).
Safety outcomes
No significant difference in hospital admissions.
Conclusion
In children aged 6-12 months with acute respiratory tract infections, CRP testing was superior to usual care with respect to the rate of antibiotic use over a 14-day follow-up.
Reference
Elvira Isaevaa, Joakim Bloch, Azamat Akylbekov et al. C-reactive protein testing in primary care and antibiotic use in children with acute respiratory tract infections in Kyrgyzstan: an open-label, individually randomised, controlled trial. Lancet. 2025 April;51(101184).
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