CRP tests and patient leaflets to reduce antibiotics for adults with respiratory infections in Kyrgyzstan

CRP and Patient Information Leaflets to Optimise Antibiotic Treatments for Adults With Respiratory Tract Infections in Primary Care in Kyrgyzstan

This project will test whether using quick CRP blood tests and easy-to-read patient information leaflets helps doctors in Kyrgyzstan prescribe fewer antibiotics for adults with recent respiratory symptoms.

Quick facts

• Phase: Not applicable
• Study type: Interventional
• Enrollment: 1050 (estimated)
• Ages: 18 Years to 70 Years
• Sex: All
• Sponsor: Rigshospitalet, Denmark (Academic / other)
• Locations: 2 sites (Sokuluk Village, Chui Region and 1 other locations)
• Trial ID: NCT07261969 on ClinicalTrials.gov

What this trial studies

This multicentre, open-label randomized trial will enroll adults (18–70) with acute respiratory symptoms at 14 rural and one urban primary care centres in Kyrgyzstan. Participants are randomized in a 2x3 design: patient information leaflet versus no leaflet, and one of three CRP point-of-care test thresholds (20, 40, or 60 mg/L), creating six groups. Clinicians will use CRP results and the leaflet allocation to guide antibiotic prescribing, with 21 days of blinded follow-up to monitor antibiotic use, clinical recovery, and safety. Primary outcomes include antibiotic prescribing and patient safety, and secondary outcomes include reconsultations and symptom duration.

Who should consider this trial

Good fit: Adults aged 18–70 presenting to participating primary care centers with acute respiratory symptoms of less than two weeks who can give informed consent and complete follow-up are ideal candidates.

Not a fit: Patients who are severely ill or need urgent referral, are immunosuppressed, pregnant, recently on antibiotics, or cannot complete follow-up are unlikely to benefit from this intervention.

Why it matters

Potential benefit: If successful, the approach could safely reduce unnecessary antibiotic prescriptions and help curb antimicrobial resistance in Kyrgyz primary care.

How similar studies have performed: Previous work, including the COORDINATE trial, showed CRP point-of-care testing can reduce antibiotic use without compromising safety, but the best CRP cut-offs for adults remain unproven.

Eligibility criteria

Inclusion Criteria:

* Adults aged 18 to 70 years with ARTI according to the attending HCW;
* Having at least one of the following respiratory symptoms lasting for less than 2 weeks (with or without a fever):

  * cough;
  * shortness of breath;
  * sore throat;
  * stuffy nose;
  * wheezing.
* Able and willing to comply with all study requirements.
* Able and willing to give informed consent.

Exclusion Criteria:

* Severely ill and in need of urgent referral where measurement of POCT CRP is not relevant or would delay the process;
* Terminally ill patients;
* Patients with known immunosuppression or severe chronic disease (HIV, liver failure, kidney failure, history of neoplastic disease, long term systemic steroid use or similar conditions as assessed by the health worker or research team);
* Patients who are not able to participate in follow-up procedures (lack of telephone etc.);
* Have taken antibiotics within 24 hours before the index consultation;
* Pregnant women;
* Unable or unwilling to provide informed consent.

Where this trial is running

Sokuluk Village, Chui Region and 1 other locations

• Sokuluk Family Medicine Center — Sokuluk Village, Chui Region, Kyrgyzstan (Recruiting)
• Azim Azhybek uulu — At-Bashy Village, Naryn Region, Kyrgyzstan (Recruiting)

Study contacts

• Study coordinator: Azamat Akylbekov, MD

Conditions Respiratory Tract Infection Bacterial; Respiratory Tract Infection Viral; AMR; CRP; Inflammation; CRP POCT; Primary care; ARVI