RM-POCT Fails to Reduce Same-Day Antibiotic Prescribing in Respiratory Tract Infection: JAMA
UK: Researchers have found in a new randomized clinical trial that among primary care patients with respiratory tract infections being considered for antibiotics, the use of rapid molecular point-of-care testing (RM-POCT) did not reduce same-day antibiotic prescribing. Importantly, patient outcomes were not adversely affected despite no significant change in antibiotic use.
The study, published in JAMA Internal Medicine, was led by Alastair D. Hay from the Centre for Academic Primary Care, Bristol Medical School, University of Bristol, and colleagues. The trial evaluated whether rapid multiplex microbiological testing at the point of care could help clinicians better target antibiotic use in routine primary care settings.
For this purpose, researchers conducted a parallel-group randomized clinical trial across 16 general practices in Southwest England between December 2022 and April 2024. The study included patients aged 1 year and older who presented with acute respiratory tract infections lasting up to 21 days, where antibiotics were being considered necessary by either the clinician or patient. A total of 552 participants were randomized equally to receive either RM-POCT or standard usual care.
Patients in the intervention group underwent a rapid test capable of detecting 19 respiratory viruses and 4 atypical bacteria, with results available in approximately 45 minutes. The primary outcome measured was same-day antibiotic prescribing, while symptom severity on days 2 to 4 was assessed as a key safety outcome.
The trial revealed the following findings:
- There was no difference in antibiotic prescribing between the RM-POCT and usual care groups.
- In both groups, 45% of patients received same-day antibiotics.
- Availability of rapid test results did not change prescribing behavior in routine practice.
- Symptom severity during early follow-up was similar between groups.
- Withholding antibiotics in the intervention group did not negatively affect patient recovery.
- Subgroup analyses indicated potential benefits in specific populations.
- Antibiotic prescribing was lower among patients with confirmed viral infections.
- Reduced antibiotic use was also observed in patients with chronic lung disease.
Overall, routine use of RM-POCT did not reduce antibiotic prescribing or worsen short-term symptoms in primary care respiratory infections. The findings suggest that pathogen-only testing may have a limited influence on real-world prescribing decisions despite its role in antimicrobial stewardship.
Key limitations included lower baseline antibiotic use in participating practices, a less diverse study population, higher-than-expected missing symptom data, and fewer pediatric participants.
The authors concluded that rapid molecular testing alone is unlikely to meaningfully reduce antibiotic prescribing in primary care, highlighting the complexity of prescribing behavior and the need for broader stewardship strategies.
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
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