Effect of Respiratory Viral Panel Testing on Antibiotic Use and Antimicrobial Resistance in Adults: A systematic review of randomized controlled trials and prospective cohort studies

Background: Antibiotic stewardship efforts often support the use of viral diagnostics to distinguish viral from bacterial in respiratory infections. However, the utility of respiratory viral panels to identify a broad spectrum of viral pathogens and reduce unnecessary antibiotic consumption is unclear. This review systematically examined studies of these molecular diagnostics to evaluate the current evidence for their use in stewardship efforts.Methods: I conducted a search of PubMed, Embase, Web of Science, Cochrane Library, and ClincalTrials.gov. Eligible studies included randomized controlled trials and prospective cohort studies that examined the effect of respiratory viral panels (concurrently examining >3 viral pathogens) for adults on changes in antibiotic prescribing habits, antimicrobial resistance patterns, or economic outcomes.Results: I included eight studies, six randomized controlled trials and two prospective cohort studies. Studies were mostly low to moderate quality. Four studies showed some small changes in antibiotic use, but effects were inconsistent and not sustained. Four studies failed to show any reductions in inappropriate antibiotic utilization at all. No studies reported data on changes in antimicrobial resistance patterns and only two reported cost data.Conclusions: Insufficient evidence exists to recommend respiratory viral panel testing as a tool to reduce unnecessary antibiotic exposure and combat antimicrobial resistance. A large multi-center randomized controlled trial with blinding and concurrent cost and resistance analysis would be required. However, future stewardship research efforts should focus on the decision-making inputs providers use and study diagnostics that more closely match these inputs.Master of Public Healt