SummaryBackground Point-of-care testing to guide antibiotic prescribing decisions is promoted for antibiotic stewardship. We investigated whether a point-of-care testing strategy for acute respiratory tract infections could safely reduce antibiotic prescribing in primary care. Methods PRUDENCE was a pragmatic, randomised controlled clinical trial in 13 countries. Patients aged 1 year or older were eligible if they presented in primary care practices or long-term care facilities with symptoms of a respiratory tract infection with either cough (lasting Findings Between Dec 15, 2021, and Jan 28, 2024, 2642 patients were randomly assigned: 1449 participants to the point-of-care testing strategy and 1193 to usual care. 2433 (92·1%) patients were in primary care (Belgium, France, Georgia, Germany, Greece, Hungary, Ireland, Poland, Spain, and the UK), and 209 (7·9%) were in long-term care facilities (Italy, Portugal, Israel, France, Ireland, and Spain). 2639 participants were included in the primary analysis (1448 54·9% assigned to point-of-care testing strategy, 1191 45·1% assigned to usual care; 1641 62·2% female patients and 998 37·8% male patients). Median follow-up was 28 days (IQR 28–28). Antibiotics were prescribed for 561 (47·1%) of 1191 participants in the usual care group and 662 (45·7%) of 1448 in the point-of-care testing group (adjusted risk difference –1·3% 95% CI –4·9 to 2·3; p=0·47). The median number of days to return to usual daily activities was 4 days (IQR 2–8) for the point-of-care testing group and 4 days (2–7) for the usual care group, with an adjusted hazard ratio of 1·00 (95% CI 0·92 to ∞; pInterpretation A point-of-care testing strategy for respiratory tract infection, which included testing for CRP, group A streptococcus, and influenza, did not reduce antibiotic prescribing when clinicians were considering prescribing or had planned to prescribe an antibiotic. Point-of-care testing is unlikely to be effective as a standalone solution in antimicrobial stewardship. Funding Innovative Medicines Initiative Joint Undertaking 2.
Velden et al. (Sun,) studied this question.