A health provider in Devon that introduced point-of-care testing (POCT) for patients presenting with an acute sore throat suspected to be Streptococcus A (Strep A), found that up to 65% of those who would have been ordinarily prescribed antibiotics did not actually require them.
Townsend, Axminster, and Seaton & Colyton Primary Care Network (PCN) began using Abbott’s ID NOW point-of-care testing platform in December 2023 as part of their clinical assessment process. After three months the PCN found that, when compared against standard processes for testing and care, there was a 55–65% reduction in immediate and deferred antibiotic prescriptions.
Current NICE guidelines recommend using a symptom scoring system such as the FeverPAIN or Centor score to identify which patients need treatment with antibiotics in suspected Strep A infections in addition to susceptible close contacts.
However, point-of-care testing in combination with these decision-making tools to support clinical assessment provides healthcare professionals with robust, evidence-based support, in the fight against antimicrobial resistance (AMR).
“Accurately differentiating between viral and bacterial infections in a primary care setting can be challenging even for highly experienced clinicians,” said Dr Rob Daniels, GP at the PCN and senior clinical lecturer at the University of Exeter.
“Having access to a rapid test, like Abbott’s ID NOW, which, with an accuracy greater than 90% is much more definitive than symptom scoring, helps us to avoid using antibiotics in viral sore throats and therefore target antibiotics to patients most in need.”
The Impact of Antimicrobial Resistance
AMR occurs when the microorganisms which cause disease (including bacteria, viruses, fungi and parasites) are no longer affected by antimicrobial medicines such as antibiotics, that are used to kill them, prevent and treat the disease. As resistance continues to increase, more people will suffer for longer as infections become more difficult to treat – resulting in longer hospital admissions, routine surgical procedures becoming more dangerous to perform, and higher death rates.
In 2022 and 2023, the UK experienced an outbreak of scarlet fever and a corresponding increase in the number of severe Strep A infections which resulted in a small number of deaths in children. This caused significant anxiety as well as increased demand for medication, putting a strain on health services and resulting in shortages of antibiotics. These events highlight the need for improved decision making around antibiotic use in suspected strep throat.
The research and findings were led by Townsend, Axminster, and Seaton & Colyton PCN and supported by Peninsula Pathology Network, the University of Exeter and Abbott.
Testing at community level
Seaton Pharmacy was also engaged as part of the study, which highlighted the role of community pharmacies in providing extra capacity for effective and accurate diagnosis and treatment under the Pharmacy First service. The increase in access to safe, effective and timely services for patients with common infections, used in conjunction with highly accurate diagnostic testing, will be hugely important going forward, especially in future scarlet fever outbreaks.
The results of this pilot study were published in the peer-reviewed Diagnostics journal.
Karen Button, the PCN manager and co-author of the paper, said: “Community pharmacy is an accessible venue for point-of-care testing, helping to support capacity within GP practices, reducing footfall in secondary care and providing patients with the right care. Ensuring that patients are only receiving antibiotics when they need them not only supports antimicrobial stewardship, but it also protects the antibiotic supply chain, reducing the chances of shortages.”
The findings also highlighted that nearly 90% of patients surveyed were reassured to learn the correct diagnosis during their consultation and 88% said they would like POCT to be available in the future. Of staff surveyed, more than 90% said testing improved treatment options and 72% would like to continue using POCT in the future.
Dr Daniels continued: “Increasing patient confidence this way is a key pillar towards improving long-term health outcomes. By establishing effective diagnostic tools within clinical practice, we can build a stronger level of trust with our patients and provide reassurance to parents and carers of children who need the right care, whilst reducing the risk of transmission.”
