Could Testing for Respiratory Infections Reduce Rate of Unnecessary Antibiotic Use?

Respiratory infections send many adults to the hospital each year, and now, a new study by researchers in the United Kingdom has investigated the role that rapid diagnostic testing can play in reducing the rate of incorrectly-administered antibiotics for viral infections.

In the United States, a study from the Centers for Disease Control and Prevention (CDC) has estimated that one in three antibiotics prescribed is unnecessary. That study, published last year in the Journal of the American Medical Association, concluded that doctors prescribe most of these unneeded antibiotics for respiratory conditions such as common colds, bronchitis, and sinus and ear infections that are caused by viruses, and thus, do not respond to antibiotic treatment. Health experts emphasize that the 47 million antibiotic prescriptions given for viral infections contribute to the ongoing problem of antibiotic resistance, giving rise to “superbugs,” and the dangerous, and at times deadly, infections that continue to occur as a result.

A recent study by University of Southamptom and National Health Service (NHS) researchers in the United Kingdom examined the role that rapid point-of-care testing (POCT) can play in quickly and accurately diagnosing viral and bacterial infections, and how these tests can help hospital personnel prescribe fewer antibiotics unnecessarily. It can take anywhere from 24 to 48 hours for respiratory infections to yield results, and during that waiting period doctors often prescribe antibiotics as a precaution. However, rapid care testing is seen as a potential way to identify the cause of an infection in real-time and prevent patients from receiving antibiotics they don’t need. Last year, NHS England launched a national program with £150 million in funding to encourage hospitals to curtail inappropriate antibiotic prescriptions.

The new study assessed the effects of rapid testing on various clinical outcomes, including antibiotic use, and took place over two winter seasons. For the study, researchers enrolled adult patients with acute respiratory illness or high fever within 24 hours of admission to the emergency department or acute medical unit of a large UK hospital. Those patients were randomly assigned to either have a molecular POCT or routine clinical care, and the researchers’ primary outcome was the proportion of patients who received antibiotics during their hospitalizations. Of the 720 patients enrolled in the study, 362 received POCT and 358 had routine care, and six patients withdrew from the study. Of the 360 patients who received POCT, 301 (84%) received antibiotics compared with 294 (83%) of the 354 who were in the routine care group.

“Routine use of molecular POCT for respiratory viruses did not reduce the proportion of patients treated with antibiotics,” the authors conclude. “However, the primary outcome measure failed to capture differences in antibiotic use because many patients were started on antibiotics before the results of POCT could be made available. Although POCT was not associated with a reduction in the duration of antibiotics overall, more patients in the POCT group received single doses or brief courses of antibiotics than did patients in the control group.”

Despite these results, lead author Tristan Clark, MD, emphasized that rapid testing for patients upon hospital admission can help caregivers give the right treatment for the right infections. “Lung infections in asthma and COPD patients are a common cause of antibiotic overuse” said Clark in a recent press release. “Tests like this, which enable tailored and personalized medicine, have a major role to play in the fight against antibiotic resistance.”