Clinical Study
Is Pathogen Molecular Testing Reshaping Outpatient Antibiotic Prescribing?
Alexander BD, Irish W, Rosato AE, Eisenstein BI, Fragala MS, Goldberg SE, Nash DB • Jan. 21, 2025
Key Summary of Published Article – Is Pathogen Molecular Testing Reshaping Outpatient Antibiotic Prescribing?
A new study published in the American Journal of Medical Quality shows that healthcare providers are using syndromic PCR-based molecular tests in clinical practice to guide antibiotic therapy and reduce empiric prescribing. This study was led by renowned experts including Barbara D. Alexander, MD, MHS, Professor of Medicine and Pathology and Vice-Chief of the Transplant Infectious Diseases Services at Duke University and Advisor to HealthTrackRx.
The Problem
Nearly one third of the 236.4 million antibiotic prescriptions dispensed from community pharmacies are unnecessary. For patients with acute upper respiratory infections, more than half receive antibiotics, even though viruses are typically responsible – making the antibiotics unnecessary. The inability to rapidly identify the pathogens causing the infection is a major contributor to this problem. Without knowing the causal pathogen, targeted treatments cannot be initiated and empiric antimicrobial therapy is common. Overprescribing unnecessary antibiotics leads to antimicrobial resistance, a major public health threat globally.
The Solution
Timely and accurate diagnosis can help to optimize targeted antibiotic treatments, combat antibiotic resistance and improve patient and population health outcomes. Improvements in test panels, specimen collection and transport, turnaround time, and result interpretation and reporting render diagnostic results that are more rapidly actionable for patients. These innovations offer a solution that may disrupt empiric antibiotic prescribing and help clinicians overcome previous reluctance to modify initial empiric antibiotic prescribing patterns based on availability of antimicrobial susceptibility reports. Yet, it remained unknown if the availability of such improved testing was being used in clinical practice to guide prescribing decisions.
The Study
This study surveyed more than 700 outpatient health care providers in the U.S. to understand if new syndromic PCR-based panels that provide pathogen-specific results within 24 hours guide prescribing decisions. Of responding providers involved with interpreting test reports and providing treatment recommendations, most (97.4%) use test results to make prescribing decisions with equal numbers prescribing upfront then adjusting treatment later if needed (i.e., empirically prescribing) (48.6%) versus awaiting test results before prescribing antibiotics (48.9%). Most also noted a positive impact of the test on prescribing patterns, including fewer and improved self-reported accuracy of antibiotic prescriptions.
Conclusion
Results indicate that outpatient healthcare providers are now using newly available molecular test panels to guide antibiotic prescribing. Nearly half are awaiting test results to determine if antibiotics are appropriate. These changes in prescribing behavior may lead to more accurate prescribing as well as fewer empiric antibiotic prescriptions.
Related Articles and White papers
Alexander BD, Irish W, Rosato AE, Eisenstein BI, Fragala MS, Goldberg SE, Nash DB • Jan. 21, 2025
Key Summary of Published Article – Is Pathogen Molecular Testing Reshaping Outpatient Antibiotic Prescribing?
A new study published in the American Journal of Medical Quality shows that healthcare providers are using syndromic PCR-based molecular tests in clinical practice to guide antibiotic therapy and reduce empiric prescribing. This study was led by renowned experts including Barbara D. Alexander, MD, MHS, Professor of Medicine and Pathology and Vice-Chief of the Transplant Infectious Diseases Services at Duke University and Advisor to HealthTrackRx.
The Problem
Nearly one third of the 236.4 million antibiotic prescriptions dispensed from community pharmacies are unnecessary. For patients with acute upper respiratory infections, more than half receive antibiotics, even though viruses are typically responsible – making the antibiotics unnecessary. The inability to rapidly identify the pathogens causing the infection is a major contributor to this problem. Without knowing the causal pathogen, targeted treatments cannot be initiated and empiric antimicrobial therapy is common. Overprescribing unnecessary antibiotics leads to antimicrobial resistance, a major public health threat globally.
The Solution
Timely and accurate diagnosis can help to optimize targeted antibiotic treatments, combat antibiotic resistance and improve patient and population health outcomes. Improvements in test panels, specimen collection and transport, turnaround time, and result interpretation and reporting render diagnostic results that are more rapidly actionable for patients. These innovations offer a solution that may disrupt empiric antibiotic prescribing and help clinicians overcome previous reluctance to modify initial empiric antibiotic prescribing patterns based on availability of antimicrobial susceptibility reports. Yet, it remained unknown if the availability of such improved testing was being used in clinical practice to guide prescribing decisions.
The Study
This study surveyed more than 700 outpatient health care providers in the U.S. to understand if new syndromic PCR-based panels that provide pathogen-specific results within 24 hours guide prescribing decisions. Of responding providers involved with interpreting test reports and providing treatment recommendations, most (97.4%) use test results to make prescribing decisions with equal numbers prescribing upfront then adjusting treatment later if needed (i.e., empirically prescribing) (48.6%) versus awaiting test results before prescribing antibiotics (48.9%). Most also noted a positive impact of the test on prescribing patterns, including fewer and improved self-reported accuracy of antibiotic prescriptions.
Conclusion
Results indicate that outpatient healthcare providers are now using newly available molecular test panels to guide antibiotic prescribing. Nearly half are awaiting test results to determine if antibiotics are appropriate. These changes in prescribing behavior may lead to more accurate prescribing as well as fewer empiric antibiotic prescriptions.
