Reviewed by: Tyler Stephen, MD, University of Rochester Medicine
In a study conducted in 16 general practices in England, 552 patients 12 months and older with a clinician-diagnosed acute respiratory tract infection were randomized to either usual care or to have the results of a respiratory microbe multiplex point-of-care test (POCT) available to providers before prescribing treatment. The PCR contained only viral and atypical bacterial targets. Clinicians were not offered any training on interpreting test results or communicating them to patients. The primary outcome was the comparison of same-day antibiotic prescribing between the two groups.
Overall, there was no difference in same-day antibiotic prescribing between the two groups, with 45% of patients in each group receiving antibiotics. Among subgroups, patients in the POCT group with a virus detected were less likely to be prescribed an antibiotic (22%). However, patients in the POCT group without a virus detected were more likely to be prescribed an antibiotic (61%). Among those with chronic lung disease, they were less likely to have antibiotics prescribed in the POCT group. No difference was noted for children, nor when patients and clinicians disagreed on antibiotic necessity.
The study overall suggests that having the results of a POCT multiplex respiratory microbe panel available alone does not reduce antibiotic prescribing for acute respiratory tract infections. This study was conducted without provider training on interpreting or communicating the test results. In real world application, provider education may be part of the rollout of such a test and would likely influence the outcome based on prior studies. It is also unclear whether the presence of typical bacteria in the POCT testing could have changed the outcome, potentially biasing providers to prescribe in the setting of negative viral and atypical testing. It is also unclear whether controversial CAP guidelines will influence real-world prescribing in the setting of a detected virus.
Reference:
Hay AD, Abbs S, Ridd M, et al. Rapid Respiratory Microbiological Point-of-Care Testing and Antibiotic Use in Primary Care: A Randomized Clinical Trial. JAMA Intern Med. Published online May 18, 2026. doi:10.1001/jamainternmed.2026.1426