Point of care testing to reduce unnecessary antibiotic use for lower respiratory tract infections in older adults in primary care: a randomised feasibility trial
Respiratory tract infections, antibiotic resistance
Group 1 – A Covid/Flu lateral flow test will be performed using a nasal swab. This test takes around 10 mins to perform. Group 2A – A Covid/Flu lateral flow test will be performed using a nasal swab. As well as this, FebriDx will also be performed. This test shows if the participant has elevated levels of CRP (an inflammatory biomarker indicative of a bacterial infection) or MxA (A marker of the antiviral immune response indicative of a viral infection). Group 2B – A Covid/Flu lateral flow test will be performed using a nasal swab. As well as this, a SureScreen CRP test will be performed. This test shows if the participant has elevated levels of CRP (an inflammatory biomarker indicative of a bacterial infection) at three different levels – 10ug/l, 40ug/l, 80mg/l Group 3 – Usual Care All treatment is to be decided by the clinician and does not need to follow the advice of the tests. Both initial prescribing decision and final prescribing decision after the tests have been complete will be logged. Randomisation is done using a program called sealed envelope. This is set up to stratify randomisation by the initial prescribing decision. The clinician simply needs to input patient ID, initial prescribing decision and if they are eligible for the study and they will be randomised. The participant will need to complete a 28 day follow up diary. Everyday they will rank their symptoms from a list from a scale of 0-6 with 0 being not at all and 6 being very severe. Once a week, patients will note down if they have received any antibiotics or antivirals for their consulting chest infection, if they’ve seen a GO again, if they’ve been hospitalised, been to A&E or an out of hours centre. After 14 days, the first half of the diary will be returned by freepost envelope and the same again after 28 days with the latter half.
1. Age 65 years or over 2. Presenting to primary care with symptoms of a lower respiratory tract infection beginning less than seven days prior to appointment. Symptoms must include an acute cough and one other symptom: 2.1. Shortness of breath 2.2. Sputum 2.3. Chest pain 3. The ability to provide written informed consent
1. Clinical diagnosis of pneumonia 2. Patient is already receiving antibiotics and/or antivirals or has used antibiotics/antivirals in the past 30 days. 3. Patient declines URT swabbing or finger prick blood testing. 4. Patient has cystic fibrosis 5. Patient has bronchiectasis 6. Patient is terminally ill 7. Patient is unable to comply with trial procedures 8. Patient has dementia, and/or is not able to consent themselves to trial procedures