***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background Despite huge public campaigns , there is still overconsumption of antibiotics in children with self-limiting diseases . Possible explanations may be the physicians ’ and parents ’ uncertainty about the gravity of the disease and inadequate communication between physicians and parents leading to lack of reassurance for the parents . In this paper we describe the design and methods of a trial aim ing to rationalize antibiotic prescribing by decreasing this uncertainty and parental anxiety . Methods / Design Acutely ill children without suspected serious disease consulting their family physician will be consecutively included in a four-armed cluster r and omized factorial controlled trial . The intervention will consist a Point-of-Care C-reactive protein test and /or a brief intervention with safety net advice . The control group will receive usual care . We intend to include 2560 patients in 88 family practice s. Patients will be followed up until cure . The primary outcome measure is the immediate antibiotic prescribing rate . Secondary outcomes are : comparison between groups of speed of clinical recovery , parental concern , parental perception of the quality of the communication , parental satisfaction , use of medication , use of diagnostic tests and medical services during the illness episode , and cost-effectiveness of the interventions . Besides this , we will observationally analyse data of the children included in the large ERNIE2-trial , but excluded in the cluster r and omized trial , namely children suspected of serious disease presenting in primary care and children who initially present at the out-patient paediatric clinic or emergency department . We will search for predictors of antibiotic prescribing , speed of clinical recovery , parental concern , parental perception of communication , parental satisfaction , use of medication , diagnostic tests and medical services . Discussion This is a unique multifaceted intervention , in that it targets both physicians and parents by aim ing specifically at their uncertainty and concerns during the consultation . Both interventions are easy to implement without special training . When proven effective , they could offer a feasible way to decrease inappropriate antibiotic prescribing for children in family practice and thus avoid emergence of bacterial resistance , side effects and unnecessary healthcare costs . Moreover , the observational part of the study will increase our insight in the course , management and parent ’s concern of acute illness in children . Trial registration Clinical Trials.gov Identifier : NCT02024282 Background Point of care testing for C-reactive protein ( CRP ) has shown promise as a measure to reduce unnecessary antibiotic prescribing in respiratory tract infections ( RTI ) , but its use in primary care is still controversial . We aim ed to evaluate the effect of CRP testing on the prescription of antibiotics , referral for radiography , and the outcome of patients in general practice with acute cough/RTI . Methods An open-cluster r and omized clinical trial was conducted , with CRP testing performed in the intervention group .  Antibiotic prescribing and referral for radiography  were the main outcome measures . Results A total of 179 patients were included : 101 in the intervention group and 78 in the control group . The two groups were similar in clinical characteristics . In the intervention group , the antibiotic prescribing rate was 37.6 % , which was significantly lower than that in the control group ( 58.9 % ) ( P = 0.006 ) . Referral for chest X-ray was also significantly lower in the intervention group ( 55.4 % ) than in the control group ( 75.6 % ) ( P = 0.004 ) . The recovery rate , as recorded by the GPs , was 92.9 % and 93.6 % in the intervention and control groups , respectively . Conclusion The study showed that  CRP testing in patients with acute cough/RTI may reduce antibiotic prescribing and referral for radiography , probably without compromising recovery . Trial registration The trial was registered in the Clinical Trials.gov Protocol Registration System ( identification number : NCT01794819 ) Summary Background Inappropriate antibiotic use for acute respiratory tract infections is common in primary health care , but distinguishing serious from self-limiting infections is difficult , particularly in low-re source setting s. We assessed whether C-reactive protein point-of-care testing can safely reduce antibiotic use in patients with non-severe acute respiratory tract infections in Vietnam . Method We did a multicentre open-label r and omised controlled trial in ten primary health-care centres in northern Vietnam . Patients aged 1–65 years with at least one focal and one systemic symptom of acute respiratory tract infection were assigned 1:1 to receive either C-reactive protein point-of-care testing or routine care , following which antibiotic prescribing decisions were made .  Patients with severe acute respiratory tract infection were excluded . Enrolled patients were reassessed on day 3 , 4 , or 5 , and on day 14 a structured telephone interview was done blind to the intervention . R and omised assignments were concealed from prescribers and patients but not masked as the test result was used to assist treatment decisions . The primary outcome was antibiotic use within 14 days of follow-up . All analyses were prespecified in the protocol and the statistical analysis plan . All analyses were done on the intention-to-treat population and the analysis of the primary endpoint was repeated in the per- protocol population . This trial is registered under number NCT01918579 . Findings Between March 17 , 2014 , and July 3 , 2015 , 2037 patients ( 1028 children and 1009 adults ) were enrolled and r and omised . One adult patient withdrew immediately after r and omisation . 1017 patients were assigned to receive C-reactive protein point-of-care testing , and 1019 patients were assigned to receive routine care . 115 patients in the C-reactive protein point-of-care group and 72 patients in the routine care group were excluded in the intention-to-treat analysis due to missing primary endpoint . The number of patients who used antibiotics within 14 days was 581 ( 64 % ) of 902 patients in the C-reactive protein group versus 738 ( 78 % ) of 947 patients in the control group ( odds ratio [ OR ] 0·49 , 95 % CI 0·40–0·61 ; p<0·0001 ) . Highly significant differences were seen in both children and adults , with substantial heterogeneity of the intervention effect across the 10 sites ( I2=84 % , 95 % CI 66–96 ) . 140 patients in the C-reactive protein group and 137 patients in the routine care group missed the urine test on day 3 , 4 , or 5 . Antibiotic activity in urine on day 3 , 4 , or 5 was found in 267 ( 30 % ) of 877 patients in the C-reactive protein group versus 314 ( 36 % ) of 882 patients in the routine treatment group ( OR 0·78 , 95 % CI 0·63–0·95 ; p=0·015 ) . Time to resolution of symptoms was similar in both groups . Adverse events were rare , with no deaths and a total of 14 hospital admissions ( six in the C-reactive protein group and eight in the control group ) . Interpretation C-reactive protein point-of-care testing reduced antibiotic use for non-severe acute respiratory tract infection without compromising patients ' recovery in primary health care in Vietnam . Health-care providers might have become familiar with the clinical picture of low C-reactive protein , leading to reduction in antibiotic prescribing in both groups , but this would have led to a reduction in observed effect , rather than overestimation . Qualitative analysis is needed to address differences in context in order to implement this strategy to improve rational antibiotic use for patients with acute respiratory infection in low-income and middle-income countries . Funding Wellcome Trust , UK , and Global Antibiotic Resistance Partnership , USA BACKGROUND Few studies have analysed adherence to antibiotic treatment in respiratory tract infections . OBJECTIVE To evaluate the impact of C-reactive protein ( CRP ) testing on treatment adherence among patients aged 18 or over with lower respiratory tract infection ( LRTI ) treated with thrice-daily antibiotic regimens .  DESIGN Prospect i ve study 2003 - 2008 . SETTING Office-based physician practice s. METHODS We compared patient adherence prior to the use of CRP testing ( no CRP test was available prior to 2007 ) with adherence following CRP rapid testing for suspected bacterial infection in LRTIs . Patient adherence was assessed by electronic monitoring . RESULTS 161 patients with LRTI were recruited . The percentage of container openings was 76.8 ± 17.4 % . Adherence was significantly better when the CRP test was performed ( 83.3 % vs. 74.4 % ; p < 0.01 ) , as was ' good timing ' adherence during at least 80 % of the antibiotic course ( 32.6 % vs. 16.9 % ; p < 0.05 ) . CONCLUSION Greater antibiotic treatment adherence is observed among patients with LRTI after CRP testing at the consultation prior to administration of antibiotic treatment Background C-Reactive protein ( CRP ) is an important diagnostic marker for serious bacterial infections in febrile children .  C-Reactive protein bedside testing could potentially accelerate the diagnostic evaluation and shorten length of stay ( LOS ) . Objective The aim of the study was to study the effect of introducing CRP bedside testing on the LOS of febrile children at the emergency department ( ED ) . Design and Intervention A prospect i ve observational study with a preimplementation cohort ( 2008 ) with traditional CRP testing and a postimplementation cohort ( 2009–2011 ) in which CRP bedside testing was introduced . Patients and Setting All previously healthy children with fever , aged 1 month to 16 years , attending the ED of a university hospital were included ; non – ill-appearing children with an upper airway infection were not eligible for CRP bedside testing . Analysis and Main Outcome Measure Multivariable linear regression and propensity score analyses were used to determine the effect of CRP bedside testing on the logarithmic transformation length of stay [ (log)LOS ] . Results The preimplementation cohort included 609 children of whom 286 ( 47 % ) had traditional CRP . The postimplementation cohort included the following 1330 children : 728 ( 55 % ) children had bedside CRP and 156 ( 12 % ) children had traditional CRP . Bedside CRP significantly lowered the median LOS of children in whom an additional diagnostic CRP test was performed , from 178 minutes ( interquartile range , 135–232 minutes ) to 148 minutes ( interquartile range , 108–200 minutes ) ( 30 minutes , 19 % of total LOS ) . A significant reduction of 15 % of the (log)LOS remained after adjusting for other determinants of (log)LOS ; propensity score analysis showed a 16 % reduction . Conclusions C-Reactive protein bedside testing substantially lowered the LOS of children with fever at the ED in whom an additional diagnostic CRP test was performed BACKGROUND Antibiotics are overprescribed for non-severe acute infections in children in primary care . AIM To explore two different interventions that may reduce inappropriate antibiotic prescribing for non-severe acute infections . DESIGN AND SETTING A cluster r and omised , factorial controlled trial in primary care , in Fl and ers , Belgium . METHOD Family physicians ( FPs ) enrolled children with non-severe acute infections into this study . The participants were allocated to one of four intervention groups according to whether the FPs performed : ( 1 ) a point-of-care C-reactive protein test ( POC CRP ) ; ( 2 ) a brief intervention to elicit parental concern combined with safety net advice ( BISNA ) ; ( 3 ) both POC CRP and BISNA ; or ( 4 ) usual care ( UC ) . Guidance on the interpretation of CRP was not provided . The main outcome was the immediate antibiotic prescribing rate . A mixed logistic regression was performed to analyse the data . RESULTS In this study 2227 non-severe acute infections in children were registered by 131 FPs . In comparison with UC , POC CRP did not influence antibiotic prescribing , ( adjusted odds ratio [ AOR ] 1.01 , 95 % confidence interval [ CI ] = 0.57 to 1.79 ) . BISNA increased antibiotic prescribing ( AOR 2.04 , 95 % CI = 1.19 to 3.50 ) . In combination with POC CRP , this increase disappeared . CONCLUSION Systematic POC CRP testing without guidance is not an effective strategy to reduce antibiotic prescribing for non-severe acute infections in children in primary care . Eliciting parental concern and providing a safety net without POC CRP testing conversely increased antibiotic prescribing . FPs possibly need more training in h and ling parental concern without inappropriately prescribing antibiotics BACKGROUND Excessive prescribing of antibiotics in patients with lower respiratory tract infections ( LRTIs ) is common in the general population . Due to communication difficulties , it is hypothesised that prescriptions are even more commonplace in the primary care of individuals with intellectual disabilities .  Point-of-care C-reactive protein ( POC-CRP ) testing might lead to more efficient prescribing of antibiotics . AIM To evaluate the effect of POC-CRP testing on antibiotic prescriptions for LRTIs by physicians specialising in the care of individuals with intellectual disabilities . DESIGN AND SETTING A prospect i ve case-control study in 
    Output:
    
We found no significant effect of point-of-care CRP testing on patient satisfaction , clinical recovery , reconsultation , further testing and hospital admission .
CONCLUSIONS Performing a point-of-care CRP test in ambulatory care accompanied by clinical guidance on interpretation reduces the immediate antibiotic prescribing in both adults and children .
As yet , available evidence does not suggest an effect on other patient outcomes or healthcare processes .