Unnecessary antibiotics in pediatric acute respiratory infection: clinical algorithm and rapid testing versus usual care

Abstract

Introduction: Acute respiratory infections are a frequent reason for visits to pediatric emergency departments and are associated with unnecessary antibiotic prescribing. Point-of-care rapid tests, when integrated into clinical algorithms, may help reduce this use.

Objectives: To assess the effect of an “algorithm plus rapid tests” strategy on antibiotic prescribing at the initial visit and its clinical safety, as well as to describe secondary outcomes and implementation of the strategy.

Methods: PRISMA 2020 systematic review. Studies published from 2020 onward were searched in MEDLINE/PubMed, Embase, Scopus, Web of Science, and CENTRAL. Children (0–18 years) seen in emergency care for acute respiratory infections were included. A narrative synthesis covered antibiotic prescribing, revisits/hospitalization/late pneumonia, and resource use/costs.

Results: Twenty-five studies were included. In randomized trials, rapid respiratory viral/multiplex testing as a stand‑alone intervention showed null or inconsistent effects on antibiotic use. In implementation studies combining clinical pathways with rapid tests (e.g., C‑reactive protein or viral diagnostics), larger reductions and improved antibiotic selection were reported. No consistent increase in clinically relevant adverse events was observed. Effects on length of stay and costs were mixed.

Conclusions: Rapid tests require integration into clinical pathways and antimicrobial stewardship programs to change prescribing. Pragmatic multicenter studies with standardized definitions and economic evaluation are needed.