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Objective To assess the effect of general practitioner testing for C reactive protein (disease approach) and receiving training in enhanced communication skills (illness approach) on antibiotic prescribing for lower respiratory tract infection.

Design Pragmatic, 2×2 factorial, cluster randomised controlled trial.

Setting 20 general practices in the Netherlands.

Participants 40 general practitioners from 20 practices recruited 431 patients with lower respiratory tract infection.

Main outcome measures The primary outcome was antibiotic prescribing at the index consultation. Secondary outcomes were antibiotic prescribing during 28 days’ follow-up, reconsultation, clinical recovery, and patients’ satisfaction and enablement.

Interventions General practitioners’ use of C reactive protein point of care testing and training in enhanced communication skills separately and combined, and usual care.

Results General practitioners in the C …