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TOPLINE:

Rapid microbiological point-of-care testing (RM-POCT) for respiratory viruses and atypical bacteria among patients with respiratory tract infections (RTIs) in primary care did not reduce same-day antibiotic prescribing compared with usual care. However, antibiotic prescribing was reduced in patients in whom a virus was detected.

METHODOLOGY:

• Researchers conducted a randomized clinical trial at 16 general practices in Southwest England (December 2022 to April 2024), enrolling 552 patients aged at least 12 months (mean age, 40.0 years; 63% female; 94% White) with clinician-diagnosed acute RTIs for which antibiotic treatment was considered potentially necessary.
• Patients were randomly assigned to either the RM-POCT group or the usual care group (n = 276 in each group). Those in the RM-POCT group received the test results in approximately 45 minutes, indicating the presence or absence of 19 respiratory viruses and four atypical bacteria.
• The primary outcome was antibiotic prescribing on the same day (either immediate or delayed) as reported by the treating clinician.
• The secondary outcome was the severity of symptoms reported by patients on days 2-4 using a validated trial diary.

TAKEAWAY:

• Same-day antibiotic prescribing occurred in 45% of patients in both the RM-POCT and usual care groups, with no significant difference observed between the two groups.
• Among patients in whom a virus was detected, antibiotic prescribing was reduced in the RM-POCT group vs usual care group (odds ratio, 0.35; 95% CI, 0.20-0.63).
• The severity of symptoms on days 2-4 showed the noninferiority of RM-POCT compared with usual care, with a difference in means of 0.09 (P = .36), as the upper bound of the CI did not exceed the predefined 20% noninferiority margin of 0.34.
• No significant differences were observed between the two groups in terms of antibiotic prescribing from days 2 to 28, participant-reported antibiotic consumption from days 1 to 28, or healthcare-seeking behavior.

IN PRACTICE:

“[The study] results suggest an RM-POCT that only tests for viruses and atypical bacteria is unlikely to be clinically effective, let alone cost-effective, in primary care,” the authors wrote.

“This trial suggests that changing the target of antibiotic prescribing within a trial of primary care-diagnosed acute respiratory infections does nothing to improve patient outcomes,” experts wrote in an invited commentary.

SOURCE:

The study was led by Alastair D. Hay, MD, of the Centre for Academic Primary Care in the Bristol Medical School, Population Health Sciences, at the University of Bristol in Bristol, England. It was published online on May 18, 2026, in JAMA Internal Medicine. The editorial was written by Jeffrey A. Linder, MD, MPH, of the Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, and Julia E. Szymczak, PhD, of the Division of Epidemiology, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City.

LIMITATIONS:

The general practices involved in the study had lower antibiotic prescribing rates than the national average and mostly served affluent, less diverse communities, which might limit the applicability of the results. Fewer children took part in the study than anticipated. There were also more dropouts than expected, which may have led to an underestimation of symptom severity and duration.

DISCLOSURES:

This trial received funding from the Efficacy and Mechanism Evaluation program, a partnership between the Medical Research Council and the National Institute for Health and Care Research (NIHR). One author received support from the National Institutes of Health, and another author received support from the UK NIHR. A third author disclosed receiving grants from Utilizer outside the submitted work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.