Impact of molecular point-of-care testing for respiratory pathogens on antibiotic use and clinical outcomes in acute respiratory tract infections: a systematic review and meta-analysis

Abstract

Background: Molecular point-of-care testing (mPOCT) offers rapid identification of respiratory pathogens, but its impact on antibiotic use and patient outcomes remains uncertain. We aimed to comprehensively evaluate the effects of mPOCT on antibiotic use and major clinical outcomes in patients presenting with acute respiratory tract infections (ARTIs). Methods: We searched MEDLINE, Embase, Web of Science, CENTRAL, CNKI, and Wanfang Data from inception to July 1, 2025, for randomised controlled trials (RCTs) evaluating mPOCT for patients presenting with ARTIs (PROSPERO CRD420251069333). The primary outcome was antibiotic use, assessed using pooled risk ratio (RR) with random-effects models. Risk of bias and certainty of evidence were assessed using the Risk Of Bias instrument for Use in SysTematic reviews-for Randomised Controlled Trials (ROBUST-RCT) and core Grading of Recommendations, Assessment, Development and Evaluation (GRADE), respectively. Findings: We included 25 RCTs involving 12,638 patients, of whom 61.0% were adults. Overall, mPOCT probably had little to no important effect on antibiotic use (RR 0.95, 95% CI 0.90–1.00; moderate certainty) or treatment duration (mean difference −0.44 days, 95% CI −0.98 to 0.09; moderate certainty). In adults, high-certainty evidence showed no effect on antibiotic use (RR 1.00, 95% CI 0.98–1.02), whereas in children, low-certainty evidence suggested a potential reduction (RR 0.79, 95% CI 0.65–0.97). Although mPOCT increased appropriate antibiotic prescribing (RR 2.07, 95% CI 1.55–2.77; moderate certainty), it did not affect 30-day mortality (RR 0.97, 95% CI 0.82–1.15; high certainty) and intensive care unit admission (RR 0.90, 95% CI 0.65–1.25; high certainty). Interpretation: Moderate to high certainty evidence suggests that mPOCT does not meaningfully reduce overall antibiotic use or improve patient outcomes, particularly in adults, despite enhancing prescribing appropriateness. Routine use of mPOCT for adults with ARTIs is therefore not supported. Funding: National Natural Science Foundation of China, the Postdoctoral Science Foundation, the Chongqing Municipality Joint Science and Health Major Medical Research Project, Outstanding Youth in Science and Technology, the Chongqing Youth Talent Fund, and the Research Foundation Flanders.