Routine testing for multiple respiratory pathogens does not reduce antibiotic consumption in acute ill children

In recent years, the microbiological diagnostics of respiratory infections has changed. Numerous multi-testing devices, which can identify the exact pathogen of a respiratory infection within about one hour of sampling, have been introduced on the market. Multi-testing devices test for approximately 20 common pathogens of respiratory tract infections simultaneously. New diagnostic devices are actively marketed, but their benefit in paediatric patients is unclear.

A study conducted by the Emergency Department for Children and Adolescents of Oulu University Hospital before the COVID-19 pandemic investigated the effects of determining the exact pathogen in a nasopharyngeal sample on antibiotic treatments started in paediatric patients.

The study involved 1,243 children under the age of 18 with fever or respiratory symptoms. The paediatric patients were randomised to two comparator groups. A nasopharyngeal sample identifying 21 common respiratory tract infections was taken from 829 children in the study group at the emergency department. The test result was received during the same emergency visit. Samples were taken from 414 children in the control group on the basis of a physician’s assessment, and the physician did not receive the nasopharyngeal sample results until the following weekday.

In the study group, 5% of the paediatric patients were diagnosed with a pathogen for which targeted drug therapy (influenza, pertussis or mycoplasma) is utilised. Nasopharyngeal sampling did not reduce the number of antibiotic treatments started, new emergency visits or the need for hospital monitoring in relation to the control group. The number of additional tests at the emergency department was the same in the study group and control group. The visit to the emergency department of patients in the study group was on average approximately 10 minutes longer than that of patients in the control group.

Rapid influenza testing has previously been shown to reduce the need for antibiotic therapy and further tests in children with respiratory symptoms. The use of multi-testing devices did not provide any additional benefit in this study. Extensive nasopharyngeal sampling of children with respiratory symptoms did not affect the treatment of paediatric patients. Therefore, based on the results of this study, routine testing of nasopharyngeal specimens in children with respiratory symptoms may not be useful in clinical practice.

The study was published in JAMA Network Open: Mattila S, Paalanne N, Honkila M, Pokka T, Tapiainen T. Effect of Point-of-Care Testing for Respiratory Pathogens on Antibiotic Use in Children: A Randomized Clinical Trial. JAMA Netw Open. 2022;5(6):e2216162. doi:10.1001/jamanetworkopen.2022.16162