Funding has been allocated for a clinical trial assessing whether respiratory infection rapid tests could reduce antibiotic prescribing in primary care.
A research team from the University of Bristol has received £1.6 million in funding from the National Institute for Health and Care Research (NIHR) to investigate whether rapid microbiological ‘point-of-care’ tests for respiratory infections could reduce antibiotic prescribing in primary care.
The rapid tests are carried out in GP surgeries rather than sent to a laboratory to detect the presence of viruses and some bacteria, with results available on the same day. The clinical trial could provide new hope to reduce antibiotic resistance in healthcare, and improve antibiotic prescribing across the NHS.
The rise of antibiotic prescribing for viral conditions
Millions of people in the UK will be prescribed antibiotics for common respiratory infections, such as coughs, colds and sore throats. This is unnecessary as respiratory infections caused by viruses cannot be helped by antibiotic prescribing, as antibiotics work on bacteria only. This overuse is contributing to antimicrobial resistance (AMR), leaving more people unequipped to tackle bacterial infections.
Can rapid tests help decision-making in healthcare?
Manufacturers are developing same-day swab tests that can detect multiple viruses associated with respiratory infections. The quick pace associated with rapid tests means healthcare professionals can make same-day decisions about antibiotic prescribing. A UK government review from 2016 has supported the use of rapid tests, seeing them as critical to improving antibiotic use.
The large randomised controlled clinical trial called RAPID-TEST will investigate whether point-of-care tests reduce antibiotic prescribing in general practice, and how. The project is built from the long-standing collaboration between the University of Bristol and the Bristol, North Somerset and South Gloucestershire NHS Integrated Care Board.
Professor Alastair Hay, a GP and Chief Investigator of the study based at the Centre for Academic Primary Care and the Bristol Trials Centre at the University of Bristol, said: “Industry is investing a lot of money in the development of these tests and the potential future cost to the NHS is high. It’s therefore important we are confident they are a good use of scarce NHS funds before they are introduced into routine care. A well-conducted clinical trial, like RAPID-TEST, is the best way to find out.
“Although it may at first seem obvious that they should be used, there are other factors to consider in addition to the cost. For example, when a virus is detected, it does not mean it is causing the infection. Some viruses can live harmlessly in our noses and throats. So, nurses and GPs must still use their judgement about whether a bacterial infection is also present.
“Second, no test is 100% accurate. It might say ‘no virus’ when an important virus is present. This means patients could be given the wrong advice or treatment. Finally, the decision to prescribe antibiotics can be influenced by factors outside the test results, such as the patient-clinician interaction and patients’ expectations for antibiotics.
“We will consider all of these factors in this trial, and will also look at whether the use of rapid point-of-care tests helps patients feel better quicker. If the tests are shown to be effective in reducing antibiotic prescribing, we will do further research on their cost-effectiveness.”