Point-of-care testing strategy versus usual care to safely reduce antibiotic prescribing for acute respiratory tract infections in primary care (PRUDENCE): a pragmatic, randomised controlled trial in 13 countries

The PRUDENCE trial evaluated whether point-of-care (POC) testing (including CRP, strep A, and influenza tests) could reduce antibiotic prescribing for respiratory tract infections in primary care across 13 countries.

In over 2,600 patients, POC testing did not significantly reduce antibiotic use compared to usual care (45.7% vs 47.1%). Importantly, patient recovery was similar in both groups, with a median of 4 days to return to normal activities, confirming that POC testing is safe but not more effective in this context.

The key takeaway: when clinicians are already inclined to prescribe antibiotics, diagnostic testing alone does not change prescribing behavior. Therefore, POC testing is unlikely to be effective as a standalone antimicrobial stewardship strategy and should be combined with behavioural, educational, and system-level interventions.