An important first checkpoint of controlling antimicrobial resistance is in primary care – Interview with Prof. Mark Ebell

Professor Mark Ebell has kindly given us an interview highlighting the importance of primary care in controlling antimicrobial resistance.

Prof. Ebell is a family physician and currently working as a Professor in the University of Georgia (Athens, Georgia, US). He also works as a volunteer GP in Mercy Clinic in Athens, GA on a weekly basis. He has several hundred publications and his research activities are focused in helping primary care physicians and their patients make better decision and make better use of information in point of care settings.

Prof. Ebell confirms that in the US, like elsewhere, the majority of antibiotics are prescribed for acute respiratory tract infections and in outpatient settings. Moreover,antibiotics courses for cough and sinus infections are usually started based on a clinical symptom evaluation without additional analyses (e.g., imaging or rapid tests) leading to an excess antibiotic prescribing. The rate of antibiotic prescriptions has the potential to be decreased from current appr. 70% possibly as low as 20%.

Prof Ebell is currently leading a 1400-patient study with the driving purpose to reduce inappropriate antibiotic prescriptions and inhibit antimicrobial resistance. A diagnostic tool combining e.g., symptoms and CRP is to be developed and validated. QuikRead go point-of-care CRP provides results for the algorithm used in the tool.

In the primary care setting, Prof. Ebell prefers CRP as an inflammatory marker over PCT because the point-of-care CRP testing has previously been shown to aid in reducing antibiotic prescriptions in primary care in European study settings¹. There is also growing body of evidence demonstrating that PCT and CRP perform similarly in identifying uncomplicated lower respiratory infections², but especially in primary care, CRP is much quicker and cheaper to obtain.

Thank you, Prof. Ebell, for your practical insight!

References

1. Tonkin-Crane SKG et al. Clinician-targeted interventions to influence antibiotic prescribing behaviour for acute respiratory infections in primary care: an overview of systematic reviews (Review). Cohcrane Database of Systematic Reviews 2017; 7(9): CD012252.
2. Ebell MH, Bentivegna M, Cai X, Chupp C, Kearney M. Accuracy of Biomarkers for the Diagnosis of Community-Acquired Pneumonia: A Meta-analysis. Acad Emerg Med 2019; in press.