Rapid RSV Tests Reduces Antibiotic Prescribing in Kids

Respiratory syncytial virus (RSV) is a major cause of viral lower respiratory tract infections in young children. Although antibiotics do not treat viral infections, they are frequently prescribed in outpatient pediatric settings where diagnostic tools to confirm viral causes are often unavailable. Now, a new study suggests that rapid antigen diagnostic tests for RSV may significantly reduce unnecessary antibiotic prescribing in young children.

In the study, investigators from the University of Milan-Bicocca (Milan, Italy) used data from a network of more than 200 family pediatricians in Italy to evaluate the use of combined rapid antigen diagnostic tests (Ag-RDTs) for COVID-19, influenza, and RSV in children aged 9 to 36 months presenting with suspected viral lower respiratory tract infections, including bronchiolitis.

A total of 256 children (median age 15 months; 52% male) were included in the study. Among them, 79 children (30.9%) tested positive for RSV, while 177 children (69.1%) tested negative. Antibiotic prescribing was significantly lower among RSV-positive children compared with RSV-negative children. The rate of antibiotic prescriptions was 0.18 per 10 person-days for RSV-positive cases versus 0.29 for RSV-negative cases.

Overall, detection of RSV using rapid antigen tests was associated with a 48% lower risk of receiving at least one antibiotic prescription (relative risk 0.52). When researchers compared clinical data from two respiratory seasons before and after rapid test implementation, they observed a 39% reduction in antibiotic prescribing during the 2023–2024 season and a 46% reduction during the 2022–2023 season.

The findings, published in JAMA Network Open, suggest that rapid RSV diagnostic tests can improve clinical decision-making by confirming viral infections at the point of care. This allows clinicians to avoid unnecessary antibiotic prescriptions and supports broader antimicrobial stewardship efforts. Researchers emphasize that larger studies are needed to evaluate the cost-effectiveness of widespread rapid RSV testing and confirm whether the findings apply across different healthcare settings.

“By improving diagnostic accuracy at the point of care, Ag-RDTs can support more targeted treatment decisions and strengthen antimicrobial stewardship,” wrote the authors.

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University of Milan-Bicocca