Evaluating the effect of C-reactive protein point-of-care testing on antibiotic prescription in children with acute respiratory infections in Kyrgyz primary care: a randomised controlled trial

<bold>Background.</bold> To combat the global antimicrobial resistance crisis and align with the research priorities of the Kyrgyz Ministry of Health, this study assessed the effectiveness and safety of CRP POCT in guiding antibiotic prescriptions for children with ARTIs in Kyrgyzstan. <bold>Method.</bold> This open-label, multicentre trial randomised children with ARTIs in primary care to either CRP POCT or usual care. Primary outcomes were antibiotic use over 14 days and caregiver-reported recovery time. Blinded follow-ups occurred on days 3, 7, and 14. <bold>Results.</bold> A total of 1,204 children were randomised (Figure 1). Antibiotic use was lower in the intervention group (216/601, 36%) compared to the control group (362/603, 60%), with a risk difference of 24 percentage points (95% CI: 15–34). Time to recovery showed no significant difference between groups (log-rank test: p=0.090), and the predefined non-inferiority margin of one day was not exceeded. Hospital admission rates were similar (CRP: 31/601, 5%; control: 26/603, 4%; OR: 1.20, 95% CI: 0.69–2.10). <bold>Discussion.</bold> The introduction of CRP POCT in primary care for paediatric ARTIs in Kyrgyzstan significantly reduced antibiotic use without compromissing safety, underscoring its potential role in national antimicrobial stewardship initiatives. <bold>Figure 1.</bold> CONSORT diagram of study flow. <fig><object-id>erj;66/suppl_69/PA580/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig>