Key Points Question Does point-of-care testing for respiratory pathogens reduce antibiotic use in acutely ill children? Findings In this randomized clinical trial of 1243 children, multiplex polymerase chain reaction point-of-care testing for respiratory pathogens did not reduce the overall prescribing of antibiotics in the emergency department (27.3% in the intervention group vs 28.5% in the control group). Meaning These findings suggest that testing for respiratory pathogens does not reduce antibiotic use in acutely ill children.

Respiratory tract infection (RTI) is one of the most frequent indications for medical care and the prescription of antibiotics in children. 1 During the last decade, molecular diagnostic tools have become widely available for fast, accurate detection of respiratory pathogens associated with RTIs, and several studies using multiplex polymerase chain reaction (PCR) panels for the detection of respiratory pathogens have shown that respiratory viruses are found in 50-90% of children with acute respiratory infection, including the most commonly detected viruses such as rhinovirus, respiratory syncytial virus (RSV), adenovirus and influenza viruses. Co-infections with multiple viruses and viral and bacterial co-infections have been reported to lead to a longer hospital stay for children. [2][3][4][5][6][7][8]

A respiratory tract infection (RTI) is the most common disease of childhood, with children aged <2 years experiencing 5 to 10 RTIs per year. 1,2 Most RTIs are caused by viruses. 1,[3][4][5] Several studies using multiplex polymerase chain reaction (PCR) for the detection of respiratory pathogens have demonstrated that viruses are found from 50% to 90% of the children evaluated due to acute respiratory infection. 2,3,5 In addition, coinfections with multiple viruses [6][7][8][9] and viralbacterial co-detections 10 are common.Data on the social burden of common RTIs in children are limited.Previous studies have shown that influenza or influenza-like diseases are associated with parental work absence. 11,12 In addition, parental absence from work caused by children's respiratory syncytial virus