Trinity Fellow Leads Major International Trial on Rapid Testing and Antibiotic Use

9 March 2026

Trinity College Oxford is pleased to share the findings of a major international clinical trial examining the impact of rapid point of care diagnostic tests on antibiotic prescribing in primary care. The PRUDENCE trial enrolled 2,639 patients across 13 European countries who presented with a cough or sore throat and whose clinician was considering prescribing antibiotics. Participants were randomly assigned to receive either usual care alone or usual care plus a tailored point of care testing strategy. Tests included C reactive protein blood tests to assess illness severity, rapid throat swabs for group A streptococcus and tests for influenza A and B, or combinations of these. Antibiotic prescribing rates were very similar between the testing group and the usual care group, and patients recovered at the same rate. Tests produced valid results in 95 percent of cases and no safety concerns were identified.

A companion qualitative study interviewed patients and clinicians in six countries to understand the use of point of care tests in routine consultations. Interviews showed the tests were most valuable where clinicians faced genuine diagnostic uncertainty, such as unclear symptoms or ambiguous clinical presentations. In these specific situations test results sometimes shifted decisions in both directions. However, several factors limited the overall impact. Clinicians frequently used test results to confirm decisions already made rather than to revise them, and when test findings conflicted with clinical experience clinicians sometimes questioned the accuracy of the tests. Patient expectations, concerns about illness severity and cultural norms around antibiotic use also shaped prescribing outcomes in ways that test results alone could not address.

The PRUDENCE trial was co led by Professor Christopher Butler, Professorial Fellow at Trinity College Oxford and Professor of Primary Care in the Nuffield Department of Primary Care Health Sciences.

"Rapid point of care tests have real potential, but our study shows that diagnostics on their own do not automatically change prescribing decisions. When clinicians are already leaning towards antibiotics, test results often reinforce that choice. To make a meaningful difference, rapid testing must be combined with clear guidance, clinician training and support to manage patient expectations."

The PRUDENCE results emphasise that rapid diagnostics must be paired with appropriate training, clinical guidance and patient centred communication strategies if they are to influence prescribing decisions meaningfully. Integrating these tools into everyday practice remains a priority as the global community seeks to preserve the effectiveness of antibiotics and address antimicrobial resistance for future generations.

Read the trial paper: Point-of-care testing strategy versus usual care to safely reduce antibiotic prescribing for acute respiratory tract infections in primary care (PRUDENCE) – van der Velden AW, Coenen S, Harper E et al. The Lancet Primary Care 2026.

Read the qualitative study: Clinician and patient experiences with point-of-care testing for acute respiratory infections in primary care: a qualitative process evaluation of the PRUDENCE trial – Wanat M, Hoste ME, Anastasaki M et al. The Lancet Primary Care 2026.

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Trinity Fellow Leads Major International Trial on Rapid Testing and Antibiotic Use

9 March 2026

Trinity College Oxford is pleased to share the findings of a major international clinical trial examining the impact of rapid point of care diagnostic tests on antibiotic prescribing in primary care. The PRUDENCE trial was co led by Professor Christopher Butler, Professorial Fellow at Trinity College Oxford and Professor of Primary Care in the Nuffield Department of Primary Care Health Sciences.

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