Effectiveness of Point-of-Care Testing to Reduce Unnecessary Antibiotic Use: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

Abstract

Background: Most antibiotics in ambulatory care are prescribed for acute respiratory and febrile illnesses that are self-limiting or viral. Point-of-care tests (POCT) can give results within the consultation and may help clinicians withhold antibiotics safely. This review estimated the effect of POCT-guided management on antibiotic prescribing and compared the evidence base with the Saudi Arabian and wider Gulf/Middle East (GCC-MENA) context.

Methods: PubMed was searched to 4 October 2026 with eight documented strategies. Randomised controlled trials (individual, cluster or stepped-wedge) in primary care, community pharmacies, nursing homes, outpatient clinics or emergency departments that compared POCT-guided care with usual care and reported antibiotic prescribing were eligible. Biomarker tests (C-reactive protein [CRP], procalcitonin [PCT]), pathogen tests (group A streptococcus [GAS], influenza and multiplex respiratory panels) and POCT-integrated algorithms were included. Risk ratios (RR) were pooled with DerSimonian–Laird random-effects models; heterogeneity was explored with prespecified subgroup, sensitivity and meta-regression analyses, and certainty was rated with GRADE.

Results: Of 377 unique records, 46 trials met the inclusion criteria and 33 trials (about 72,680 participants) contributed to meta-analysis. POCT-guided care reduced antibiotic prescribing (RR 0.73 (95% CI 0.68–0.78); I² = 93%; 95% prediction interval 0.51–1.05; moderate certainty). At the median control-arm prescribing rate of 60%, this corresponds to about 16 fewer prescriptions per 100 patients (number needed to test about 6). Effects were consistent for CRP (RR 0.79 (95% CI 0.74–0.83); 17 trials), and present but more heterogeneous for PCT (RR 0.63 (95% CI 0.44–0.89)) and GAS tests (RR 0.70 (95% CI 0.49–0.99)); viral tests were not clearly effective (RR 0.78 (95% CI 0.56–1.09)). Benefits were seen in high-income and low- and middle-income countries, and recovery outcomes were generally similar between arms. No randomised trial from Saudi Arabia or the GCC was identified, although Saudi observational studies report antibiotic prescribing in 24–79% of upper respiratory and pharyngitis consultations.

Conclusions: POCT, particularly CRP with clear prescribing guidance, reduces antibiotic prescribing in ambulatory care by roughly a quarter without evident harm. The effect depends on how tests are embedded in decision rules and communication. Pragmatic trials in Saudi primary care, emergency departments and community pharmacies are needed before national scale-up.