New finger prick tests trialled to inform better prescribing

GPs could one day use finger prick tests and throat swabs to immediately determine whether common respiratory infections are bacterial, and require antibiotics, or viral.
 
Several general practices in Victoria are taking part in research by Deakin University to trial two new tests for bacterial infection – a finger prick blood test (point-of-care C-reactive protein (CRP) test) in patients with respiratory symptoms, which measures the level of CRP in a drop of blood, and a throat swab (streptococcus A pharyngitis test) which confirms the presence of streptococcus A in patients who present with acute sore throat. 
 
Results are available within minutes, allowing GPs to make informed decisions at the point of care.
 
Following small-scale studies which began last year, researchers will launch a larger pilot trial of the two tests across multiple GP clinics in May to explore their impact on prescribing.
 
Deakin University research fellow Dr Sajal Saha said the tests help doctors more accurately assess the cause of common respiratory illnesses and decide on optimal treatments. They also support GPs in their communication with patients who demand antibiotics but don’t need them.
 
‘During patient consultation, the test can be done by a GP, or a nurse if appropriate, to avoid diagnostic uncertainty over whether the infection is bacterial or viral, with a result in two to three minutes if positive,’ he told newsGP.
 
Diagnostic uncertainty is one of the many contributing factors to overprescribing reported by GPs, along with patient and parent self-diagnosis, and limited training and resources, Dr Saha added.
 
Early trial results from two of the participating GP clinics show the simple, low-cost finger prick test can reduce antibiotic use by up to 30%. Dr Saha said the throat swab test for Strep A bacteria would also help ensure optimal antibiotic treatment.
 
‘Strep A is a common cause of throat infection and doctors prescribe antibiotics in around 70% of cases. But Strep A is only responsible for around 15–20% of sore throats, so the level of overprescription is very high,’ he said.
 
Associate Professor Paresh Dawda, a member of the RACGP Expert Committee – Quality Care, told newsGP these tests could play a role in helping with antimicrobial stewardship.
 
‘The differentiation between viral and bacterial infections is important, and technologies that have the potential to help distinguish is positive,’ he said.
 
However, he warned implementing any new technology must take into consideration benefits and harms.
 
‘Once the efficacy of an intervention is proven, there are also significant implementation challenges that need to be considered to make it scalable,’ Associate Professor Dawda said.
 
For RACGP Rural Chair Associate Professor Michael Clements, there was definite potential for a positive impact.
 
‘This would be valuable in rural and remote communities as we often have to make decisions on transfer to a hospital or a retrieval based on symptoms but having a clearer idea of likely pathogen means we can make better decisions,’ he told newsGP.
 
The researchers said the trials had the potential to significantly improve the safe use of antibiotics in Australia, ‘one of the highest antibiotic-prescribing countries in the developed world’.
 
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antibiotics antimicrobial resistance antimicrobials