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A recent review suggests that the routine application of rapid respiratory viral tests in emergency departments (EDs) offers limited benefits for antimicrobial stewardship. Presented in JAMA Internal Medicine, the review examined 11 randomized clinical trials involving patients with acute respiratory infections (ARIs) seeking care in EDs. It revealed that while rapid viral testing led to increased usage of influenza antivirals among positive cases (absolute risk difference 1%), it did not significantly impact overall antibiotic use, duration of ED visits, return visits to the ED, or hospitalization rates. Researchers from Canada, Germany, and the United Kingdom analyzed studies published since 1984 focusing on ED rapid respiratory virus testing with their primary outcome centered on its association with antibiotic prescribing during ED visits. Secondary outcomes included influenza antiviral use, additional testing, length of ED stays, ED return visits, and hospitalization rates. Despite some trials demonstrating reduced antibiotic prescriptions following positive rapid viral tests for influenza, that trend was not consistent in the studies that used the newer molecular tests capable of detecting multiple viruses.

What’s the real-world impact? The authors advocate for a selective approach, recommending the reserved use of these tests for cases where results would alter treatment decisions. Although these tests can differentiate between viral and bacterial respiratory infections, potentially reducing unnecessary antibiotic prescriptions, findings indicate that they may not consistently influence antibiotic usage. 

Rapid Viral Tests Best When They Inform Treatment Decisions