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Table 1 Definitions of DPs and POC-CRPT and related guidelines

From: Implementing interventions to reduce antibiotic use: a qualitative study in high-prescribing practices

Delayed (also referred to as back-up or deferred) antibiotic prescriptions (DPs)

 The NICE defines DP as a prescription “given in a way to delay the use of [the antibiotic], and with advice to only use it if symptoms worsen or don’t improve within a specified time. The prescription may be given during the consultation (which may be a post-dated prescription) or left at an agreed location for collection at a later date​”. (NICE Glossary)

NICE guidance recommends considering DPs for:

• acute cough in patients with higher risk of complications,

• acute sore throat (with FeverPAIN scores of 2 or more or Centor score 3–4),

• acute otitis media (unless systemically very unwell or high risk of complications),

• sinusitis if there is no improvement for more than 10 days (unless systemically very unwell or high risk of complications),

• lower urinary tract infections for non-pregnant women.

(Summary of antimicrobial prescribing guidance – managing common infections; updated in March 2020, available on: https://www.nice.org.uk/Media/Default/About/what-we-do/NICE-guidance/antimicrobial%20guidance/summary-antimicrobial-prescribing-guidance.pdf)

Point-of-care C-Reactive Protein Testing (POC-CRPT)

 C-reactive protein (CRP) is a marker of inflammation that increases 4–6 h after the onset of inflammation or acute tissue injury and peaks at 36–90 h (1.5–4 days). Various point-of-care CRP tests are available that require a small blood sample from a finger prick and that produce a quantitative or semi-quantitative result within approx. 3 to 10 min.

NICE clinical guideline [CG191] supports the use of POC-CRPT to help differentiate a serious infection from a self-limiting RTI in adults with acute cough (lower RTI) when, after clinical assessment, a diagnosis of pneumonia has not been made. It suggests interpreting POC-CRPT results as follows:

• CRP < 20 mg/l: no routine antibiotic

• CRP between 20 and 100 mg/l: delayed/back-up antibiotic

• CRP > 100 mg/l: immediate antibiotic.