Reducing unnecessary antibiotic prescriptions for acute respiratory infections could help prevent antimicrobial resistance and save the NHS up to £89 million

Implementation of point-of-care tests could support decisions on when antibiotic prescriptions for acute respiratory infections are necessary, saving money for the NHS and safeguarding the efficacy of common antibiotics.

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A study published in the Journal of Medical Economics demonstrates how the NHS could save up to £89 million by running point-of-care diagnostic tests to more clearly determine the appropriate treatment for acute respiratory infections. This could also act to prevent antimicrobial resistance, which can result from the overuse of antibiotics and threatens to lessen the power of antimicrobial medications against bacterial infections.

The research team, led by John Schneider at Avalon Health Economics (NJ, USA), observed that despite concerns over the additional expense associated with implementing point-of-care testing, the associated reduction in unnecessary prescriptions for acute respiratory infections could result in an overall saving for the NHS.

Acute respiratory infections such as sinusitis, pharyngitis, acute cough and bronchitis account for more than two-thirds of the total antibiotic prescriptions for all medical conditions, despite many resulting from viral infections, which do not respond to antibiotics. Approximately half of consultations for acute respiratory infections result in antibiotics being prescribed, while guidelines for prescriptions suggest this figure should be much lower, at 9%.

In this study, the team employed information from NICE to assess the different costs of antibiotic prescriptions, testing and costs associated with adverse effects of taking antibiotics for acute respiratory infections.

When considering integrating currently available point-of-care tests into outpatient triage – which aim to differentiate viral and bacterial protein biomarkers – the researchers predicted an £89 million healthcare saving. With newer point-of-care tests, which have yet to be made commercially available, the team suggest this healthcare saving could rise to as much as £178 million per year.

While healthcare practitioners are aware of the detriments of over-prescription of antibiotics, this study also suggests some GPs may not perceive their own prescription decisions as contributing to costs. In a survey of 1000 UK GPs, 55% had felt pressure from patients or parents to prescribe antibiotics, even when they weren’t sure it was necessary; 44% reported having prescribed antibiotics in order to get the patient to leave the clinic or surgery.

Schneider suggests point-of-care testing may not only improve decision making, but also provide support to healthcare providers when faced with pressure to prescribe antibiotics: "A major benefit of [point-of-care testing] is the ability to improve antibiotic stewardship in the primary and urgent care setting by providing tangible results that both increase diagnostic certainty and confidence to delay or withhold antibiotics when bacterial infection is unlikely."

The team also note the applicability of their research in other countries: "Outside of the UK, similar antibiotic pressures are felt in lower- and middle-income countries and access to inexpensive testing may have an even greater impact on resource limited regions. What is more astounding, is that these cost savings do not include the potential costs related to the management of antibiotic resistance itself."


Schneider JE, Boehme C, Borisch B, Dittrich S. Application of a simple point-of-care test to reduce UK healthcare costs and adverse events in outpatient acute respiratory infections. J. Med. Econ. doi:10.1080/13696998.2020.1736872 (2020) (Epud ahead of print);

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Celeste Brady

Commissioning Editor, Future Science Group

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