Could rapid testing in the emergency department impact antibiotic use?

Acute respiratory illness is a common reason for a child to visit the emergency department. Such illnesses also have a history of being treated with antibiotics, despite many of them being viral. An investigation in JAMA Network Open examined whether the use of rapid respiratory testing in children who present with acute respiratory illness at an emergency department could lead to a decrease in antibiotic use.¹

The investigators performed a randomized clinical trial in children aged 1 month to 18 years who presented to an emergency department with an influenza-like illness between December 2018 and November 2019. Each child had a nasopharyngeal swab for rapid respiratory pathogen testing and were then randomized 1:1 to the intervention or control group, which involved results from the testing not given, routine care. The results of the test were available 45 minutes later.

There were a total of 931 emergency department visits, 452 in the intervention group and 456 in the control group. A positive result came back for 795 for rapid respiratory pathogen tests. The most common pathogens identified were enterovirus/rhinovirus (n=295), influenza (n=180), respiratory syncytial virus (n=162), and adenovirus (n=115) (children may have had ≥1 pathogen). The median age of the children was 2.1 years. Many of the patients were boys (509 children), Hispanic (478 children), had government insurance (688 children), and had high-risk medical conditions (314 children). In intention-to-treat analyses, the children in the intervention group were more likely to be given antibiotics (relative risk [RR], 1.3; 95% CI, 1.0-1.7), and have a diagnosis that would have an indication for antibiotics (risk difference, 8.6; 95% CI, 3.2-13.8). In adjusted intention-to-treat analysis, children in the intervention group were more likely to have longer emergency department length of stay (RR, 1.6 95% CI, 1.5-1.7), have higher hospitalization rates (RR, 2.0; 95% CI, 1.5-2.7), and be given appropriate antiviral medication (RR, 2.5; 95% CI, 1.5-4.2), when compared to the control group.

The investigators concluded that the use of rapid respiratory pathogen testing in the emergency department when a child presents with influenza-like illness was noted linked to a decrease in antibiotic prescribing. Overall, the greatest effect found was appropriate antiviral use, which offers support for the potential of rapid molecular influenza testing.

Reference

1. Rao S, Lamb M, Moss A, et al. Effect of rapid respiratory virus testing on antibiotic prescribing among children presenting to the emergency department with acute respiratory illness. JAMA Netw Open. 2021;4(6):e2111836. doi:10.1001/jamanetworkopen.2021.11836