Current Evidence and Gaps for Outpatient Respiratory Tract Infection Diagnostics: A Call to Action.

Abstract

Antimicrobial stewardship programs (ASPs) are underrepresented in outpatient settings, where antibiotic use and overprescribing are common. Upper respiratory tract infections (URIs) account for 30% of outpatient antibiotic prescriptions, highlighting the need for enhanced ASP efforts. Rapid diagnostic testing (RDT) has important value in management of outpatient URIs, such as pharyngitis, and can lead to optimized prescribing practices and significant reductions in unnecessary antimicrobial use by facilitating accurate diagnoses. Implementation of outpatient RDTs is hindered by a lack of streamlined workflows, resources, and ASPs. These gaps often lead to suboptimal use of RDTs and misinterpretation of or failure to act on the results. Future RDT evaluations should include strategies to curtail unnecessary antibiotics and expand point-of-care testing (POCT) to additional settings to enhance antimicrobial stewardship. This paper reviews outpatient RDT initiatives, and specifically POCT, in URIs. Additionally, we highlight the need for more evidence demonstrating the impact on clinical outcomes and antibiotic prescribing with the implementation of RDTs.