Rapid tests reduce antibiotic prescribing for respiratory infections in primary care- suggests the trial by University of Bristol

Every year, millions of people in the UK seek help for respiratory infections, such as coughs, colds, chest infections, sore throats and earaches. On average, GPs and nurses give antibiotics to half of these patients. This is more than is necessary because most respiratory infections are caused by viruses, including COVID-19, but antibiotics only work on bacteria. This is needlessly contributing to antimicrobial resistance (AMR), but since clinicians don’t always know who needs them, they are often given ‘just in case’.

Manufacturers are developing same-day swab tests that can detect multiple viruses associated with respiratory infections in as little as 45 minutes – fast enough for clinicians to make same-day decisions about whether to prescribe antibiotics. A UK government review published in 2016 supports their use, seeing them as critical to improving antibiotic use.

RAPID-TEST is a large randomised controlled clinical trial that will investigate whether point-of-care tests really do reduce antibiotic prescribing in general practice, and how. The project is part of a long-standing collaboration between the University of Bristol and the Bristol, North Somerset and South Gloucestershire NHS Integrated Care Board.

Professor Alastair Hay, a GP and Chief Investigator of the study based at the Centre for Academic Primary Care and the Bristol Trials Centre at University of Bristol, said: “Industry is investing a lot of money in the development of these tests and the potential future cost to the NHS is high. It’s therefore important we are confident they are a good use of scarce NHS funds before they are introduced into routine care. A well-conducted clinical trial, like RAPID-TEST, is the best way to find out.

“Although it may at first seem obvious that they should be used, there are other factors to consider in addition to cost. For example, when a virus is detected, it does not mean it is causing the infection. Some viruses can live harmlessly in our noses and throats. So, nurses and GPs must still use their judgement about whether a bacterial infection is also present.

“Second, no test is 100% accurate. It might say ‘no virus’ when an important virus is present. This means patients could be given the wrong advice or treatment. Finally, the decision to prescribe antibiotics can be influenced by factors outside the test results, such as the patient-clinician interaction and patients’ expectations for antibiotics.

“We will consider all of these factors in this trial, and will also look at whether the use of rapid point-of-care tests helps patients feel better quicker. If the tests are shown to be effective in reducing antibiotic prescribing, we will do further research on their cost-effectiveness.”

Lord Jim O’Neill, who chaired the UK government commissioned AMR review published in May 2016, said: “Many people will remember the AMR review recommended the use of rapid diagnostics to reduce unnecessary antibiotic use, so I am delighted that the NIHR has chosen to fund this important clinical trial. We know from Professor Hay’s previous research that the tests are popular with GPs and nurses. With this trial there is the opportunity to find out how effective they can be.”