Rapid Respiratory Microbiological Point-of-Care Testing and Antibiotic Use in Primary Care: A Randomized Clinical Trial

Alastair D Hay; Samantha E Abbs; Matthew J Ridd; Stephen Granier; J. Athene Lane; Peter Muir; Jodi Taylor; Grace Young; Kathy Eastwood; Hayley A Dash; Lynne M Bradshaw; Rebecca Clarke; Pui Yi Lui; Emma L Bridgeman; Rachel C M Brierley; Emily L Brown; Hannah V Thornton; Paul M Mitchell; Liang Zhu; Lucy Yardley; Chris Metcalfe

doi:10.1001/jamainternmed.2026.1426

Rapid Respiratory Microbiological Point-of-Care Testing and Antibiotic Use in Primary Care: A Randomized Clinical Trial

Alastair D Hay^*, Samantha E Abbs, Matthew J Ridd, Stephen Granier, J. Athene Lane, Peter Muir, Jodi Taylor, Grace Young, Kathy Eastwood, Hayley A Dash, Lynne M Bradshaw, Rebecca Clarke, Pui Yi Lui, Emma L Bridgeman, Rachel C M Brierley, Emily L Brown, Hannah V Thornton, Paul M Mitchell, Liang Zhu, Lucy YardleyChris Metcalfe

^*Corresponding author for this work

Research output: Contribution to journal › Article (Academic Journal) › peer-review

1 Citation (Scopus)

Abstract

IMPORTANCE

Most antibiotic prescribing takes place in primary care, driving antimicrobial resistance, a top-10 threat to global public health. There is considerable international interest in whether rapid multiplex microbiological point-of-care testing (RM-POCT) can safely reduce antibiotic prescribing in primary care.

OBJECTIVE

To investigate whether the use of a RM-POCT can safely reduce same-day antibiotic prescribing for children and adults presenting to primary care with respiratory infections.

DESIGN, SETTING, AND PARTICIPANTS

This parallel-group randomized clinical trial was conducted at 16 general practices in Southwest England between December 2022 and April 2024. Patients were eligible if they were aged 12 months or older, presented with any clinician-diagnosed acute (≤21 days) respiratory tract infection, and the patient or clinician believed antibiotic treatment was, or might be, necessary. Participants were randomized (1:1) to RM-POCT or usual care. The research team, including those conducting statistical analyses, were unaware of group allocation. Data were analyzed from November 21, 2024, to March 13, 2025.

INTERVENTION

Patients in the intervention group were tested with RM-POCT to indicate the presence or absence of 19 respiratory viral pathogens and 4 atypical bacteria in approximately 45 minutes.

MAIN OUTCOMES AND MEASURES

The primary outcome was same-day antibiotic prescribing. The safety outcome was patient-reported symptom severity on days 2 to 4.

RESULTS

Among 552 included patients (mean [SD] age, 40.0 [21.2] years; 349 [63%] female), 276 were randomized to the intervention group and 276 to usual care. Primary outcome data were available for all participants, and safety outcome data were available in 216 intervention participants (78%) and 203 usual care participants (74%). Same-day antibiotics were prescribed to 124 participants (45%) in each group (odds ratio [OR], 1.00 [95% CI, 0.71 to 1.41]; P > .99). Prespecified subgroup analyses showed evidence of differentially reduced antibiotic prescribing in participants from whom a virus was detected (OR, 0.35 [95% CI, 0.20 to 0.63]; P for interaction < .001) and those with chronic lung disease (OR, 0.55 [95% CI, 0.28 to 1.09]; P for interaction = .046) but not children younger than 16 years (OR, 1.75 [95% CI, 0.64 to 4.74]; P for interaction = .24), nor where patients and clinicians disagreed on antibiotic necessity (OR, 1.12 [95% CI, 0.63 to 1.98]; P for interaction = .53). There was no difference in symptom severity on days 2 to 4 between groups (difference in means, 0.09 [95% CI, −0.10 to 0.27]; P = .36).

CONCLUSIONS AND RELEVANCE

In this randomized clinical trial among patients with respiratory tract infections being considered for antibiotic treatment in primary care, use of an RM-POCT did not reduce same-day antibiotic prescribing or worsen patient outcomes.

Trial Registration isrctn.org Identifier: ISRCTN16039192.

Original language	English
Number of pages	10
Journal	JAMA Internal Medicine
Early online date	18 May 2026
DOIs	https://doi.org/10.1001/jamainternmed.2026.1426
Publication status	E-pub ahead of print - 18 May 2026

Bibliographical note

Publisher Copyright:
© 2026 Hay AD et al.

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Hay, A. D., Abbs, S. E., Ridd, M. J., Granier, S., Lane, J. A., Muir, P., Taylor, J., Young, G., Eastwood, K., Dash, H. A., Bradshaw, L. M., Clarke, R., Lui, P. Y., Bridgeman, E. L., Brierley, R. C. M., Brown, E. L., Thornton, H. V., Mitchell, P. M., Zhu, L., ... Metcalfe, C. (2026). Rapid Respiratory Microbiological Point-of-Care Testing and Antibiotic Use in Primary Care: A Randomized Clinical Trial. JAMA Internal Medicine. Advance online publication. https://doi.org/10.1001/jamainternmed.2026.1426

@article{ca3a2aa57f3546a18d1abc4a7caac441,

title = "Rapid Respiratory Microbiological Point-of-Care Testing and Antibiotic Use in Primary Care: A Randomized Clinical Trial",

abstract = "IMPORTANCE Most antibiotic prescribing takes place in primary care, driving antimicrobial resistance, a top-10 threat to global public health. There is considerable international interest in whether rapid multiplex microbiological point-of-care testing (RM-POCT) can safely reduce antibiotic prescribing in primary care. OBJECTIVE To investigate whether the use of a RM-POCT can safely reduce same-day antibiotic prescribing for children and adults presenting to primary care with respiratory infections. DESIGN, SETTING, AND PARTICIPANTS This parallel-group randomized clinical trial was conducted at 16 general practices in Southwest England between December 2022 and April 2024. Patients were eligible if they were aged 12 months or older, presented with any clinician-diagnosed acute (≤21 days) respiratory tract infection, and the patient or clinician believed antibiotic treatment was, or might be, necessary. Participants were randomized (1:1) to RM-POCT or usual care. The research team, including those conducting statistical analyses, were unaware of group allocation. Data were analyzed from November 21, 2024, to March 13, 2025. INTERVENTION Patients in the intervention group were tested with RM-POCT to indicate the presence or absence of 19 respiratory viral pathogens and 4 atypical bacteria in approximately 45 minutes. MAIN OUTCOMES AND MEASURES The primary outcome was same-day antibiotic prescribing. The safety outcome was patient-reported symptom severity on days 2 to 4. RESULTS Among 552 included patients (mean [SD] age, 40.0 [21.2] years; 349 [63\%] female), 276 were randomized to the intervention group and 276 to usual care. Primary outcome data were available for all participants, and safety outcome data were available in 216 intervention participants (78\%) and 203 usual care participants (74\%). Same-day antibiotics were prescribed to 124 participants (45\%) in each group (odds ratio [OR], 1.00 [95\% CI, 0.71 to 1.41]; P > .99). Prespecified subgroup analyses showed evidence of differentially reduced antibiotic prescribing in participants from whom a virus was detected (OR, 0.35 [95\% CI, 0.20 to 0.63]; P for interaction < .001) and those with chronic lung disease (OR, 0.55 [95\% CI, 0.28 to 1.09]; P for interaction = .046) but not children younger than 16 years (OR, 1.75 [95\% CI, 0.64 to 4.74]; P for interaction = .24), nor where patients and clinicians disagreed on antibiotic necessity (OR, 1.12 [95\% CI, 0.63 to 1.98]; P for interaction = .53). There was no difference in symptom severity on days 2 to 4 between groups (difference in means, 0.09 [95\% CI, −0.10 to 0.27]; P = .36). CONCLUSIONS AND RELEVANCE In this randomized clinical trial among patients with respiratory tract infections being considered for antibiotic treatment in primary care, use of an RM-POCT did not reduce same-day antibiotic prescribing or worsen patient outcomes. Trial Registration isrctn.org Identifier: ISRCTN16039192.",

author = "Hay, \{Alastair D\} and Abbs, \{Samantha E\} and Ridd, \{Matthew J\} and Stephen Granier and Lane, \{J. Athene\} and Peter Muir and Jodi Taylor and Grace Young and Kathy Eastwood and Dash, \{Hayley A\} and Bradshaw, \{Lynne M\} and Rebecca Clarke and Lui, \{Pui Yi\} and Bridgeman, \{Emma L\} and Brierley, \{Rachel C M\} and Brown, \{Emily L\} and Thornton, \{Hannah V\} and Mitchell, \{Paul M\} and Liang Zhu and Lucy Yardley and Chris Metcalfe",

note = "Publisher Copyright: {\textcopyright} 2026 Hay AD et al.",

year = "2026",

month = may,

day = "18",

doi = "10.1001/jamainternmed.2026.1426",

language = "English",

journal = "JAMA Internal Medicine",

issn = "2168-6106",

publisher = "American Medical Association",

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Hay, AD, Abbs, SE, Ridd, MJ, Granier, S, Lane, JA, Muir, P, Taylor, J , Young, G, Eastwood, K, Dash, HA, Bradshaw, LM, Clarke, R , Lui, PY, Bridgeman, EL, Brierley, RCM , Brown, EL, Thornton, HV, Mitchell, PM , Zhu, L , Yardley, L & Metcalfe, C 2026, 'Rapid Respiratory Microbiological Point-of-Care Testing and Antibiotic Use in Primary Care: A Randomized Clinical Trial', JAMA Internal Medicine. https://doi.org/10.1001/jamainternmed.2026.1426

TY - JOUR

T1 - Rapid Respiratory Microbiological Point-of-Care Testing and Antibiotic Use in Primary Care

T2 - A Randomized Clinical Trial

AU - Hay, Alastair D

AU - Abbs, Samantha E

AU - Ridd, Matthew J

AU - Granier, Stephen

AU - Lane, J. Athene

AU - Muir, Peter

AU - Taylor, Jodi

AU - Young, Grace

AU - Eastwood, Kathy

AU - Dash, Hayley A

AU - Bradshaw, Lynne M

AU - Clarke, Rebecca

AU - Lui, Pui Yi

AU - Bridgeman, Emma L

AU - Brierley, Rachel C M

AU - Brown, Emily L

AU - Thornton, Hannah V

AU - Mitchell, Paul M

AU - Zhu, Liang

AU - Yardley, Lucy

AU - Metcalfe, Chris

PY - 2026/5/18

Y1 - 2026/5/18

N2 - IMPORTANCE Most antibiotic prescribing takes place in primary care, driving antimicrobial resistance, a top-10 threat to global public health. There is considerable international interest in whether rapid multiplex microbiological point-of-care testing (RM-POCT) can safely reduce antibiotic prescribing in primary care. OBJECTIVE To investigate whether the use of a RM-POCT can safely reduce same-day antibiotic prescribing for children and adults presenting to primary care with respiratory infections. DESIGN, SETTING, AND PARTICIPANTS This parallel-group randomized clinical trial was conducted at 16 general practices in Southwest England between December 2022 and April 2024. Patients were eligible if they were aged 12 months or older, presented with any clinician-diagnosed acute (≤21 days) respiratory tract infection, and the patient or clinician believed antibiotic treatment was, or might be, necessary. Participants were randomized (1:1) to RM-POCT or usual care. The research team, including those conducting statistical analyses, were unaware of group allocation. Data were analyzed from November 21, 2024, to March 13, 2025. INTERVENTION Patients in the intervention group were tested with RM-POCT to indicate the presence or absence of 19 respiratory viral pathogens and 4 atypical bacteria in approximately 45 minutes. MAIN OUTCOMES AND MEASURES The primary outcome was same-day antibiotic prescribing. The safety outcome was patient-reported symptom severity on days 2 to 4. RESULTS Among 552 included patients (mean [SD] age, 40.0 [21.2] years; 349 [63%] female), 276 were randomized to the intervention group and 276 to usual care. Primary outcome data were available for all participants, and safety outcome data were available in 216 intervention participants (78%) and 203 usual care participants (74%). Same-day antibiotics were prescribed to 124 participants (45%) in each group (odds ratio [OR], 1.00 [95% CI, 0.71 to 1.41]; P > .99). Prespecified subgroup analyses showed evidence of differentially reduced antibiotic prescribing in participants from whom a virus was detected (OR, 0.35 [95% CI, 0.20 to 0.63]; P for interaction < .001) and those with chronic lung disease (OR, 0.55 [95% CI, 0.28 to 1.09]; P for interaction = .046) but not children younger than 16 years (OR, 1.75 [95% CI, 0.64 to 4.74]; P for interaction = .24), nor where patients and clinicians disagreed on antibiotic necessity (OR, 1.12 [95% CI, 0.63 to 1.98]; P for interaction = .53). There was no difference in symptom severity on days 2 to 4 between groups (difference in means, 0.09 [95% CI, −0.10 to 0.27]; P = .36). CONCLUSIONS AND RELEVANCE In this randomized clinical trial among patients with respiratory tract infections being considered for antibiotic treatment in primary care, use of an RM-POCT did not reduce same-day antibiotic prescribing or worsen patient outcomes. Trial Registration isrctn.org Identifier: ISRCTN16039192.

AB - IMPORTANCE Most antibiotic prescribing takes place in primary care, driving antimicrobial resistance, a top-10 threat to global public health. There is considerable international interest in whether rapid multiplex microbiological point-of-care testing (RM-POCT) can safely reduce antibiotic prescribing in primary care. OBJECTIVE To investigate whether the use of a RM-POCT can safely reduce same-day antibiotic prescribing for children and adults presenting to primary care with respiratory infections. DESIGN, SETTING, AND PARTICIPANTS This parallel-group randomized clinical trial was conducted at 16 general practices in Southwest England between December 2022 and April 2024. Patients were eligible if they were aged 12 months or older, presented with any clinician-diagnosed acute (≤21 days) respiratory tract infection, and the patient or clinician believed antibiotic treatment was, or might be, necessary. Participants were randomized (1:1) to RM-POCT or usual care. The research team, including those conducting statistical analyses, were unaware of group allocation. Data were analyzed from November 21, 2024, to March 13, 2025. INTERVENTION Patients in the intervention group were tested with RM-POCT to indicate the presence or absence of 19 respiratory viral pathogens and 4 atypical bacteria in approximately 45 minutes. MAIN OUTCOMES AND MEASURES The primary outcome was same-day antibiotic prescribing. The safety outcome was patient-reported symptom severity on days 2 to 4. RESULTS Among 552 included patients (mean [SD] age, 40.0 [21.2] years; 349 [63%] female), 276 were randomized to the intervention group and 276 to usual care. Primary outcome data were available for all participants, and safety outcome data were available in 216 intervention participants (78%) and 203 usual care participants (74%). Same-day antibiotics were prescribed to 124 participants (45%) in each group (odds ratio [OR], 1.00 [95% CI, 0.71 to 1.41]; P > .99). Prespecified subgroup analyses showed evidence of differentially reduced antibiotic prescribing in participants from whom a virus was detected (OR, 0.35 [95% CI, 0.20 to 0.63]; P for interaction < .001) and those with chronic lung disease (OR, 0.55 [95% CI, 0.28 to 1.09]; P for interaction = .046) but not children younger than 16 years (OR, 1.75 [95% CI, 0.64 to 4.74]; P for interaction = .24), nor where patients and clinicians disagreed on antibiotic necessity (OR, 1.12 [95% CI, 0.63 to 1.98]; P for interaction = .53). There was no difference in symptom severity on days 2 to 4 between groups (difference in means, 0.09 [95% CI, −0.10 to 0.27]; P = .36). CONCLUSIONS AND RELEVANCE In this randomized clinical trial among patients with respiratory tract infections being considered for antibiotic treatment in primary care, use of an RM-POCT did not reduce same-day antibiotic prescribing or worsen patient outcomes. Trial Registration isrctn.org Identifier: ISRCTN16039192.

U2 - 10.1001/jamainternmed.2026.1426

DO - 10.1001/jamainternmed.2026.1426

M3 - Article (Academic Journal)

C2 - 42149561

SN - 2168-6106

JO - JAMA Internal Medicine

JF - JAMA Internal Medicine

ER -

Rapid Respiratory Microbiological Point-of-Care Testing and Antibiotic Use in Primary Care: A Randomized Clinical Trial

Abstract

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