Impact of point-of-care PCR testing on antibiotic prescribing in pediatric outpatients with acute respiratory infections: A randomized clinical trial

Background

Respiratory pathogen diagnosis has been recommended as a core element of outpatient antibiotic stewardship in the United States since 2016, and it has shown effective results. However, its implementation is mainly in developed countries, with limited research in developing countries, particularly among children.

Methods

We conducted a randomized, parallel-controlled clinical trial in the outpatient department of a tertiary children's hospital between July 2023 and November 2023. Participants with symptoms or signs of acute respiratory infections (ARTIs) as their chief complaint and illness duration of 7 days or less were screened for eligibility and randomized (1:1) to receive point-of-care (POC) PCR testing or routine care only. The primary outcome was the proportion of patients prescribed antibiotics on the day of enrollment. Secondary outcomes included the types of antibiotics prescribed and the time to fever resolution. Log-binomial regression models to estimate relative risks (RR) and their 95 % confidence intervals (CI) for the primary and secondary outcomes.

Results

We assessed 1871 patients with ARTIs for eligibility, and 1000 were finally included. Compared with the control group, the implementation of the POC PCR resulted in an 11 % reduction in antibiotic prescriptions in the intervention group (RR, 0.83; [95 %CI, 0.75–0.92]), of which antibiotics reduced 10.8 % in the “watch” group. Time to fever resolution and hospitalization rates showed no significant differences.

Conclusions

The POC PCR testing effectively reduced antibiotic prescriptions in pediatric patients with ARTIs, without compromising patients' clinical outcomes, enhancing the evidence that it is a promising tool for antibiotic stewardship.