Hay, Alastair, Abbs, Samantha, Ridd, Matthew, Granier, Stephen, Lane, Athene, Muir, Peter, Taylor, Jodi, Young, Grace, Eastwood, Kathy, Dash, Hayly, Bradshaw, Lynne, Clarke, Rebecca, Lui, Mandy, Bridgeman, Emma, Brierley, Rachel, Brown, Emily, Thornton, Hannah, Yardley, Lucy and Metcalfe, Chris (2025) O01 Rapid respiratory microbiological POCTs and antibiotic use in primary care: the RAPID-TEST RCT. JAC-Antimicrobial Resistance, 7 (Suppl. 1). (doi:10.1093/jacamr/dlae217.001).
Abstract
Background: antibiotics are prescribed for over 50% of RTIs in primary care, despite good evidence most patients do not benefit. Rapid multiplex microbiological point‐of‐care‐tests (POCTRM) determine the presence/ absence of respiratory pathogens in 15 min. Whether POCTRM reduce antibiotic prescribing without worsening patient outcomes is not known.
Objectives: to investigate whether POCTRM can (i) reduce same‐day antibiotic prescribing for children and adults presenting to primary care with RTIs; and (ii) change symptom severity on Days 2 to 4.
Methods: patients 12+ months with a RTI where the clinician and/or patient believed antibiotic treatment was, or may have been necessary, presenting to 16 GP practices in SW England. Patients individually randomized to BioFire® FilmArray® Torch 1 testing for 19 viruses and four atypical bacteria; or usual care.
Results: recruitment opened December 2022 and ended April 2024. A total of 552 participants were randomized: 63% female; 86% aged 16+ years; 95% self-reported white ethnicity; 26% had chronic lung disease; 5% reported a temperature >38°C; 14% reported tachycardia (age-adjusted); 8% reported tachypnoea (age-adjusted); 1% had oxygen saturation <94%. Ninety-five percent provided a dual throat and nasal swab, and clinician diagnoses included: acute cough (17%); common cold (14%); acute pharyngitis/ tonsillitis (13%); acute lower RTI (11%); chest infection (9%); sore throat (9%); and infective exacerbation of chronic lung disease (7%). Outcome data completeness: 548 (99%) with antibiotic prescribing; 414 (76%) with Day 2 to 4 symptom severity.
Conclusions: full results will be available for conference. This globally original RCT will provide important evidence regarding the role of rapid multiplex microbiological point-of-care-tests in primary care.
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