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Katie E Webster, Tom Parkhouse, Sarah Dawson, Hayley E Jones, Emily L Brown, Alastair D Hay, Penny Whiting, Christie Cabral, Deborah M Caldwell & Julian PT Higgins

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Katie E Webster ^1,*, Tom Parkhouse ¹, Sarah Dawson ^1,2, Hayley E Jones ^1,4, Emily L Brown ³, Alastair D Hay ³, Penny Whiting ^1,4, Christie Cabral ^1,3, Deborah M Caldwell ^1,4, Julian PT Higgins ^1,2

¹ NIHR Bristol Evidence Synthesis Group, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
² NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
³ Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
⁴ Bristol TAG, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
^* Corresponding author Email: katie.webster@bristol.ac.uk

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Responses to this report

Response by Dr Katie Webster on 6 November 2024 at 4:33 PM
Author response to comment

Thank you for your interest in our article, and for providing this comment. We note the different approaches taken by our review team and the authors of the Cochrane review. Our review considers the diagnostic accuracy of point-of-care tests to determine whether respiratory infections are bacterial or viral. In contrast, the Cochrane review cited addresses the value of CRP tests to guide antibiotic treatment (regardless of the accuracy of diagnosis).

Whilst the conclusions from our review were that current evidence does not support the use of point-of-care testing to diagnose a bacterial or viral infection, we do agree that point-of-care tests may provide additional, important benefits by reducing unnecessary antibiotic prescriptions.

It is interesting to consider how a poorly performing diagnostic test is influencing prescribing behaviour. We have previously hypothesised (1) that the low prevalence of elevated inflammatory markers - around 10% in primary care consultations - are providing "3rd party reassurance" that antibiotics are not necessary.

1. Thornton HV, Khalid T, Hay AD. Point-of-care testing for respiratory infections during and after COVID-19. Br J Gen Pract. 2020 Nov 26;70(701):574-575. doi: 10.3399/bjgp20X713561. PMID: 33199292; PMCID: PMC7679147.

Response by Professor Jonathan Cooke and Professor Timothy Felton on 14 October 2024 at 1:21 PM
Point-of-care-tests for RTI

“Thank you for the article “Diagnostic accuracy of point-of-care tests for acute respiratory infection: a systematic review of reviews” We found the content and methodology were well done and which we mainly agree with. We agree that the diagnosis of whether a respiratory tract infection is of viral or bacterial aetiology is often difficult and that symptoms and signs have poor diagnostic accuracy for bacterial respiratory infection. However, we would disagree with the statement in the abstract summary that “Currently evidence is insufficient to support routine use of point-of-care tests in primary and emergency care.” In the article’s discussion you quote “Despite their limited diagnostic accuracy, the use of CRP tests for people with ARI may reduce antibiotic prescribing without increasing negative health outcomes, in part because they may enable clinicians to communicate a ‘no antibiotic’ treatment decision more easily.” This a direct quote from the Cochrane Systematic Review(1) that reviewed 12 randomised or cluster randomised trials in 10,218 participants presenting in primary care with symptoms of respiratory tract infection. The results demonstrate that the use of CRP POCT, as a negative prognostic marker, can significantly reduce prescribing of antibiotics for RTI in primary care. We strongly believe that any intervention that reduces inappropriate antibiotic prescribing, without compromising clinical outcomes, should be adopted to address the inexorable rise in Antimicrobial Resistance.

1. Smedemark SA, Aabenhus R, Llor C, Fournaise A, Olsen O, Jørgensen KJ. Biomarkers as point-of-care tests to guide prescription of antibiotics in people with acute respiratory infections in primary care. Cochrane Database Syst Rev 2022;10(10):Cd010130. (In eng). DOI: 10.1002/14651858.CD010130.pub3.