RSV Rapid Antigen Tests May Reduce Antibiotic Prescribing in Pediatric Primary Care

Respiratory syncytial virus (RSV) is one of the most common causes of viral lower respiratory tract infections (VLRTIs) in young children, responsible for an estimated 33 million episodes annually worldwide. Despite guidelines confirming antibiotics offer no benefit for viral infections, these agents are routinely prescribed for RSV-related illnesses in outpatient settings, a pattern that fuels antimicrobial resistance (AMR) and unnecessary adverse effects. A retrospective cohort study published in JAMA Network Open suggests RSV antigen rapid diagnostic tests (Ag-RDTs) could be a practical, point-of-care tool to support more appropriate prescribing decisions.^1-3

Study Design

The study was led by researchers at the University of Milan-Bicocca and used data from the Pedianet network, an independent registry of more than 200 Italian family pediatricians. Researchers enrolled 256 children aged 9 to 36 months with suspected VLRTIs during the 2023–2024 respiratory season who underwent a combination COVID-19/influenza/RSV Ag-RDT. Of these, 79 (30.9%) tested RSV positive, and 177 (69.1%) were RSV negative. Tested children were compared against matched historical cohorts of children with clinically diagnosed VLRTIs or bronchiolitis who had not undergone laboratory testing. The primary outcome was any antibiotic prescription within 14 days of diagnosis, excluding prescriptions linked to confirmed bacterial coinfections.³

Key Findings

RSV-positive children had meaningfully lower antibiotic prescribing rates (0.18 prescriptions per 10 person-days) compared with RSV-negative children (0.29 per 10 person-days), representing a 48% reduction in risk (RR, 0.52; 95% CI, 0.33-0.83). Ag-RDT implementation overall, regardless of RSV status, was associated with reduced prescribing compared with untested, clinically diagnosed cohorts across both seasons studied (RR, 0.54-0.61). Reductions were most pronounced among RSV-confirmed VLRTI cases (RR, 0.33-0.41), suggesting that a confirmed viral etiology empowers clinicians to withhold antibiotics with greater confidence.³

Antibiotic Overuse in Context

The antibiotic overuse problem these findings address is well documented. A 2021 analysis of US ambulatory data found antibiotics were prescribed in approximately 60% of outpatient pediatric visits for bronchiolitis and bronchitis, with primary care settings showing even higher rates (60.9%) than pediatric emergency departments (40.3%). These prescribing patterns carry significant consequences: inappropriate antibiotic use is a leading driver of AMR, and broader adoption of rapid diagnostics has been associated with improved stewardship outcomes in pediatric outpatient settings.^4-6

Limitations and Implications

The cohort was small (n = 256), conducted within a single network in northern Italy, and could not adjust for disease severity. An accompanying commentary acknowledged these constraints while affirming the research as a meaningful step forward in understanding how rapid RSV testing affects antibiotic prescribing in primary care. The study authors also note that although universal RSV immunoprophylaxis with nirsevimab (Beyfortus; AstraZeneca and Sanofi) has demonstrated effectiveness in infants, its use is primarily limited to children under 8 months or those at high risk in a second RSV season. For the 9- to 36-month age group, which falls outside prophylaxis eligibility, Ag-RDTs may serve as a critical frontline stewardship tool.^3,7,8

What Is the Pharmacist’s Role?

Pharmacists can support this effort by counseling caregivers on the viral nature of RSV, reinforcing appropriate antibiotic use expectations, and advocating for point-of-care testing access in community settings.

"RSV Ag-RDT [rapid antigen diagnostic tests] may serve as a valuable tool to assist clinicians in distinguishing viral from bacterial etiologies and in guiding more appropriate treatment decisions," Riccardo Boracchini, MSc, lead study author from the University of Milan-Bicocca, wrote in JAMA Network Open. “This study's findings underscore the importance of combining RSV prevention strategies, including universal immunoprophylaxis, with Ag-RDT implementation and broader antimicrobial stewardship efforts to enhance prescribing practices."

REFERENCES

1. Li Y, Wang X, Blau DM, et al; RESCEU investigators. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in children younger than 5 years in 2019: a systematic analysis. Lancet. 2022;399(10340):2047-2064. doi:10.1016/S0140-6736(22)00478-0

2. Global Action Plan on Antimicrobial Resistance. World Health Organization. January 1, 2016. Accessed March 9, 2026. https://www.who.int/publications/i/item/9789241509763

3. Boracchini R, Brigadoi G, Salvadori S, et al; Pedianet Network Group. RSV detection and antibiotic prescribing decisions for pediatric respiratory tract infections. JAMA Netw Open. 2026;9(3):e260409. doi:10.1001/jamanetworkopen.2026.0409

4. Snyder RL, King LM, Hersh AL, Fleming-Dutra KE. Unnecessary antibiotic prescribing in pediatric ambulatory care visits for bronchitis and bronchiolitis in the United States, 2006-2015. Infect Control Hosp Epidemiol. 2021;42(5):612-615. doi:10.1017/ice.2020.1231

5. King LM, Bruxvoort KJ, Tartof SY, Lewnard JA. Pediatric antibiotic use associated with respiratory syncytial virus and influenza in the United States, 2008-2018. J Infect Dis. 2025;232(5):e811-e823. doi:10.1093/infdis/jiaf309

6. Xie Y, Chen T, Liu B, et al. Impact of real-time, on-demand influenza and respiratory syncytial virus testing at point-of-care on antibiotic prescribing and clinical outcome in pediatric outpatients with acute respiratory illness: a prospective, quasi-randomized, controlled study. Influenza Other Respir Viruses. 2026;20(1):e70205. doi:10.1111/irv.70205

7. Pelletier JH, Rush SZ, Robinette E, et al. Nirsevimab administration and RSV hospitalization in the 2024-2025 season. JAMA Netw Open. 2025;8(9):e2533535. doi:10.1001/jamanetworkopen.2025.33535

8. Committee on Infectious Diseases. Recommendations for the prevention of RSV disease in infants and children: policy statement. Pediatrics. 2025;156(5):e2025073923. doi:10.1542/peds.2025-073923