Role of Point-of-Care C-reactive Protein Testing on Antibiotic Prescription in Febrile Children: A Randomized Controlled Trial

Background Overprescription of antibiotics in febrile children contributes significantly to antimicrobial resistance. Point-of-care testing (POCT) for C-reactive protein (CRP) may help differentiate bacterial from viral infections and support more rational antibiotic use. Objective To assess the effectiveness of POCT CRP testing in reducing antibiotic prescription rates among febrile children in an outpatient pediatric setting. Methods A randomized controlled trial was conducted at a tertiary care hospital in Maharashtra, India, involving 208 children aged one month to 18 years with febrile illness (≤5 days). Participants were randomized into two groups: Group 1 (n=106) received POCT CRP testing, and Group 2 (n=102) received standard clinical care. CRP was measured using the LumiraDx fluorescence immunoassay (LumiraDx UK Ltd, Alloa, UK). The primary outcome was the rate of antibiotic prescription. Results Antibiotic prescription was significantly higher in Group 1 (59.4%) than in Group 2 (46.1%) (p=0.023). Within the POCT group, 84.2% of children with CRP >20 mg/L were prescribed antibiotics compared to 45.6% with CRP ≤20 mg/L (p=0.0001). Elevated CRP levels were significantly associated with antibiotic prescription, especially in cases of fever and abdominal pain. Conclusion POCT CRP influenced physicians' prescribing decisions, particularly when CRP levels exceeded 20 mg/L. However, without structured integration into clinical algorithms, its use alone did not reduce overall antibiotic use. Physician training and adherence to CRP-based guidance are essential to optimize the benefits of POCT CRP in antimicrobial stewardship.