Reducing antibiotic prescribing with rapid POC respiratory infection test

Reducing antibiotic prescribing with rapid POC respiratory infection test
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A new study has suggested that a rapid point-of-care diagnostic test for respiratory infections could help to reduce prescribing of antibiotics.

There are currently very high rates of antibiotic prescribing in the UK and the government has called for the introduction of rapid diagnostics to help curb overuse. This new study, by researchers at the Centre for Academic Primary Care, University of Bristol, and funded by the National Institute for Health Research, evaluated the use of a microbiological point-of-care test to assess the feasibility of using the test in primary care in preparation for a clinical trial.

It also sought to discover what GPs and nurses thought about using the test, and whether test results changed clinical decisions about diagnosis and treatment.

The findings have been published in the journal Family Practice.

Reducing antibiotics prescriptions

The RAPID-TEST study evaluated the use of the BioFire® Filmarray® v1.7 (bioMérieux) microbiological point-of-care test – uses swabs from the nose and back of the throat and gives results in around 65 minutes – in four GP practices in the South West of England over six weeks.

The test is able to detect 17 different types of respiratory virus and three atypical respiratory bacteria, however, it does not test for the most typical bacteria that cause respiratory infections because these can also live harmlessly in the nose and throat.

The study found that of the 93 patients tested, 58% had at least one virus, 37% tested negative for any virus or bacteria, 3% an inconclusive result, and 2% had an atypical bacterium.

Before the test, clinicians prescribed antibiotics to 35% of patients who, were found to have no pathogen following the test, and to 25% of patients who were found to have a virus after the test. The researchers highlight that this demonstrates the potential of the tests to reduce unnecessary antibiotic prescribing.

The study also found that clinicians changed the diagnosis in one in five patients following testing.

Alastair Hay, Professor of Primary Care at the Centre for Academic Primary Care, who led the study, said: “Point-of-care tests for multiple respiratory viruses and bacteria are available in the UK but mainly used in hospital settings. Our study is the first to assess the feasibility of their use in primary care. The results show the potential of these tests to improve diagnostic certainty and reduce unnecessary antibiotic prescribing, which is vital in the global fight against antimicrobial resistance.

“This was a small-scale feasibility study and clinical trials are now needed to see if these point-of-care tests can safely and cost-effectively reduce antibiotic prescribing in primary care.”

Lord Jim O’Neill, Chair Chatham House, who led an independent review into antimicrobial resistance in the UK from late 2014 to September 2016, said: “I have long since believed in quick, affordable, state-of-the-art, point-of-care diagnostics, so I hugely welcome this study and its findings. I hope this unlocks so much more in the area, which is crucial to meeting the challenge of antimicrobial resistance.”

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