Role of diagnostic testing in reducing unnecessary antibiotic use for upper respiratory tract infections in Chinese primary healthcare: a mixed-methods study

Abstract Backgrounds Antimicrobial resistance (AMR) is a growing global concern, driven by inappropriate antibiotic use, particularly in primary healthcare(PHC). The treatment of upper respiratory tract infections (URTIs), which are mostly of viral etiology, is a major source of such misuse. Limited access to diagnostic tools may contribute to unnecessary prescribing. This study examines whether the availability of diagnostic tools reduces unnecessary antibiotic use for URTIs in primary healthcare settings of China, with particular attention to facility-level availability of C-reactive protein (CRP) testing. Methods A mixed-methods approach was employed, integrating a cross-sectional survey of general practitioners (GPs) with an analysis of their prescription records and in-depth interviews with a subset of GPs. Quantitative analysis involved descriptive statistics and multilevel logistic regression to assess whether facility-level availability of CRP testing was associated with antibiotic prescribing for URTIs, whereas qualitative interviews explored the contextual influences on clinical decision-making. Results A total of 108 general practitioners from 30 PHC facilities filled out the questionnaires. Records of 12,489 prescriptions for URTI issued by these physicians were retrieved, of which 7,706 contained at least one antibiotic, with a URTI antibiotic prescribing rate of 61.7%. Among the 30 PHC facilities, 11 (36.7%) were equipped with CRP testing. Multilevel logistic regression models showed that CRP-test availability was associated with lower odds of antibiotic prescribing for URTIs (OR = 0.74; 95%CI:0.56–0.98; p = 0.033). Interviews with GPs revealed that limited access to diagnostic tools increased uncertainty in clinical decision-making, whereas access to such tools supported more evidence-informed prescribing and improved communication with patients. Conclusions C-reactive protein testing and other diagnostic tools play an important role in enabling rational antibiotic prescribing in PHC facilities. Strengthening diagnostic capacity and ensuring ongoing professional training for GPs represent essential strategies to curb inappropriate antibiotic use, mitigating the progression of antimicrobial resistance.