A new randomized controlled clinical trial led by the University of Bristol will examine whether rapid “point-of-care” microbiological testing for respiratory infections can reduce antibiotic prescribing in primary care, according to the National Institute for Thanks for 1,6 Millions of pounds in funding for Health and Nursing Research (NIHR). The tests, carried out in a general practitioner’s office and not sent to a laboratory, detect the presence of viruses and some bacteria, with results available the same day.
Millions of people seek help in the UK each year for respiratory infections such as coughs, colds, respiratory infections, sore throats and earaches. On average, GPs and nurses prescribe antibiotics for half of these patients. This is more than necessary as most respiratory infections are caused by viruses, including COVID-19, but antibiotics only work on bacteria. This unnecessarily contributes to antimicrobial resistance (AMR), but because doctors don’t always know which ones they need, they’re often given “just in case.”
Manufacturers are developing same-day swab tests that can detect many viruses associated with respiratory infections in less than 45 minutes — fast enough for doctors to make same-day antibiotic prescribing decisions. A UK government review published in 2016 supports their use and considers it important to improve the use of antibiotics.
Rapid-Test is a large randomized controlled clinical trial investigating whether and how point-of-care testing actually reduces antibiotic prescribing in general medicine. This 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, GP and lead investigator on the study at the University of Bristol’s Center for Academic Primary Care and Bristol Trial Centre, said: “There is a lot of industry investment in the development and potential future of these tests. The costs for the NHS are high. It is therefore important that we are confident that they are making good use of scarce NHS funds before being introduced into routine care. A well-conducted clinical study like RAPID-TEST is the best way to find out.
“While it may seem obvious at first glance that they should be used, there are other factors to consider besides cost. For example, if a virus is detected, it does not mean that it will cause an infection. Some viruses can survive harmlessly in our nose and throat. Nursing staff and general practitioners therefore still have to assess whether a bacterial infection is also present.
“Second, no test is 100% accurate. It can say “no virus” when significant virus is present. This means patients may be misadvised or treated. Finally, antibiotic prescribing decisions can be influenced by factors outside of test results, such as: B. Patient-physician interactions and patient expectations of antibiotics.
“We will consider all of these factors in this study and also see if the use of rapid point-of-care testing helps patients feel better faster. If the tests prove effective in reducing antibiotic prescribing, we will conduct further research into their cost-effectiveness.”
Lord Jim O’Neill, Chair of the UK Government-commissioned AMR review, published in May 2016, said: “Many will remember that the AMR review recommended the use of rapid diagnostics to identify the unnecessary reduce use of antibiotics. I am pleased that the NIHR has decided to fund this important clinical study. We know from previous research by Professor Hay that the tests are popular with GPs and nurses. With this study it is possible to find out how effective they can be.”
More information about the study can be found on the study website.
GPs practicing in the South West of England and wishing to participate should contact the study team at [email protected]
This week is World Antimicrobial Awareness Week (November 18-24).
Editorial staff: “Point-of-care testing for respiratory infections during and after COVID-19” by Hannah Thornton, Tanjila Khalid, and Alastair D He British Journal of General Practice (BJGP)
Listen to the BJGP Podcast – a more in-depth discussion with Professor Alistair Hay on the issues raised in the BJGP Editorial.
About the Academic Basic Supply Center
The Academic Primary Care Center (CAPC) at the University of Bristol is a leading center for primary care research in the UK, one of nine that make up the NIHR Schools for Primary Care Research. This internationally recognized center of excellence in population health research and education is located within Bristol Medical School.
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About Bristol Test Center
The Bristol Trials Center (BTC) is a UKCRC registered clinical trials entity. We offer a wide range of expertise in study methodology, study design, study management, statistical analysis and data management, including custom database design. This internationally recognized center of excellence in population health research and education is located within Bristol Medical School.
follow on twitter: @BrsTrialsCenter
The mission of the National Institute for Health and Care Research (NIHR) is to improve the nation’s health and wealth through research. We will do it:
- Funding high-quality, timely research that benefits the NHS, public health and social care;
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- attracting, training and supporting the best researchers to solve complex health and social challenges;
- Working with other public funders, charities and industry to help shape a coherent and globally competitive research system;
- Funding applied global health research and education to meet the needs of the poorest in low- and middle-income countries.
The NIHR is funded by the Department of Health and Social Care. His work in low- and middle-income countries is funded primarily by UK government aid.