Recently, Professor Yin Xiaoxv's team from the School of Public Health has achieved new progress in antimicrobial stewardship. Their findings were published in The Lancet Regional Health - Western Pacific, an internationally authoritative journal, under the title "Effect of a comprehensive package based on combined C-reactive protein and serum amyloid A point-of-care testing on antibiotic prescribing for acute respiratory tract infections at village clinics in China: a cluster randomised controlled trial." This study provides the first evidence in the primary care setting of village clinics in China that a comprehensive intervention package based on combined C-reactive protein and serum amyloid A point-of-care testing (CRP&SAA POCT) can effectively mitigate the irrational use of antibiotics at the grassroots level. Furthermore, it explores the underlying mechanisms driving the success of this intervention, offering robust evidence-based management insights for understanding the current landscape of inappropriate antibiotic use and for formulating effective intervention strategies.
Citation: Xu M, Wang J, Zhang Z, Ge E, Zhu Y, Li J, Gong Y, Lu Z, Wei X, Yin X. Effect of a comprehensive package based on combined C-reactive protein and serum amyloid A point-of-care testing on antibiotic prescribing for acute respiratory tract infections at village clinics in China: a cluster randomised controlled trial. Lancet Reg Health West Pac. 2026 May 25;71:101888. doi: 10.1016/j.lanwpc.2026.101888. PMID: 42239972; PMCID: PMC13227237.
Background：Antibiotic misuse is a primary driver of antimicrobial resistance, with particularly high rates of inappropriate antibiotic use observed in rural China. Acute respiratory tract infections (ARIs) are the leading cause of antibiotic prescriptions in village clinics; however, the vast majority of these cases are viral in etiology and do not warrant antibiotic therapy. In recent years, the advancement of POCT technologies has presented new opportunities for differentiating bacterial from viral infections, thereby offering a novel approach to curbing the overprescription of antibiotics for ARIs in village clinics.
Research progress：Based on combined CRP&SAA POCT, a cluster randomized controlled trial was conducted across 40 village clinics in Hubei Province. The results demonstrated significant efficacy of the intervention package: it not only reduced the antibiotic prescription rate for ARIs in village clinics by a relative 20%, but also substantially curtailed high-risk prescribing behaviors, including a 60% relative decrease in multiple antibiotic prescription rate and a 31% relative decrease in intravenous antibiotic prescription rate. Furthermore, the study elucidated the underlying mechanisms driving this success. While antibiotic use declined markedly, patients' out-of-pocket medication costs did not significantly decrease; instead, the utilization of traditional Chinese medicine (TCM) increased significantly. This suggests that TCM may have served as a "buffer." By maintaining continuity of care, it effectively mitigated village doctors' resistance stemming from concerns over potential income loss or the need to meet patient expectations, thereby providing critical support for the successful implementation of this evidence-based intervention at the primary care level.
Future expectations：This study shows that a comprehensive intervention package based on combined CRP&SAA POCT can safely and effectively reduce antibiotic use among rural patients with ARIs, providing evidence-based management insights into the current landscape of inappropriate antibiotic use in village clinics and the formulation of effective intervention strategies. Future implementation efforts should focus on investigating the barriers and facilitators to POCT adoption within specific health system contexts. It is imperative to develop cost-effective strategies to promote the large-scale rollout and application of this technology in primary care.
