Role of diagnostics in antibiotic prescribing

Lower respiratory tract infection is one of the most common acute reasons for patients to seek medical assessment, accounting for 17 million consultations in the European Union and 11 million in the US each year.1  Despite robust evidence highlighting little or no benefit from antibiotic treatment for most people presenting with respiratory tract infection symptoms, these illnesses are still the commonest reason for antibiotic prescribing in primary care.2 At the recent Reducing HCAIs conference on Tackling Antimicrobial Resistance, experts discussed the potential role of point of care (POC) diagnostics in helping to improve antibiotic stewardship.

Professor Jonathan Cooke, The Centre for Infection Prevention and Management, Imperial College London, commented: “We know there is a linear relationship between antimicrobial prescribing in GP practices and the development of antimicrobial resistance.” He pointed out that there has been an increase in prescribing of antibiotics in primary care, in the UK, although the message appears to be getting through with regards to reducing prescribing of cephalosporins and quinolones. However, he added that there is also great heterogeneity in prescribing, with ‘hotspots’ in primary care across the UK, as well as wide variation in secondary care.

“Now that we are starting to collect this data, perhaps we can start doing something about it,” he commented. He pointed out that most of the respiratory tract infections seen in primary care are viral. Around 80% of people presenting with complicated respiratory tract infections will receive an antibiotic. He commented that it would be desirable to have the ability to have greater precision in prescribing, adding that diagnostics are key to the optimum management of patients. “It is pointless having the wrong diagnosis and giving a toxic medicine to make things better,” he asserted.