Point-of-care testing has been highlighted for years as a vital tool to cut down on unnecessary antibiotic prescriptions. The logic is simple: if clinicians get a quick C-reactive protein (CRP) result, a group A streptococcus test, or an influenza result during the visit, they’ll prescribe fewer antibiotics for cases that are actually viral.
The PRUDENCE trial, published in The Lancet Primary Care on 17 March, tested that assumption across 13 European countries. The results are worth sitting with.
This was a practical randomised controlled trial (RCT) involving 2,639 patients aged one year and older. They had a respiratory tract infection (RTI) and were seen in primary or long-term care. Clinicians were already thinking about or had planned to prescribe an antibiotic. Patients were randomised into two groups. One group received a tailored point-of-care testing strategy. This included CRP for cough, group A streptococcus for sore throat, and influenza A/B during flu season. The other group received usual care only.
The primary outcome was antibiotic prescribing. There was no difference between the two groups. Point-of-care testing did not reduce it. Patient outcomes were equivalent too. No harm, but no benefit in terms of prescribing behaviour.
The companion qualitative evaluation, published alongside the main trial, is arguably the more revealing paper. Interviews with clinicians and patients across six countries found that test results were frequently overridden. When a CRP came back low but the clinician felt the patient looked unwell, or when the patient clearly expected antibiotics, the test lost. Clinical intuition and social dynamics won.
This is just one trial, so it’s too early to say that point-of-care testing has no role in stewardship. Previous studies, particularly those embedding CRP testing within structured communication training (such as the GRACE-INTRO and IMPAC3T trials), have shown reductions in prescribing. PRUDENCE adds a key point: testing done alone, without a larger framework, might not change behaviour. The technology is not the bottleneck. The bottleneck occurs when the result goes against a clinician’s instinct. It also depends on whether the consultation structure allows for action.
In UK primary care, CRP testing is becoming more common and may even be incentivised. This serves as a helpful reality check. Around 90% of antibiotics are prescribed in primary care, and most are for respiratory tract infections. To tackle antimicrobial resistance (AMR), the PRUDENCE data shows that investing in conversation may be just as important as investing in testing.
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