Antibiotic resistance is a growing concern. The PRUDENCE and ADEQUATE trials therefore aim to assess the impact of reducing antibiotic prescriptions on the emergence of resistant antimicrobials.

The PRUDENCE trial focuses on a comprehensive point-of-care testing strategy for CRP, strep A, influenza A+B, and SARS-CoV-2, targeting patients with lower or upper respiratory symptoms. The trial spans primary and long-term care across multiple countries with varying diagnostic practices. Unlike past studies, PRUDENCE considers patient recovery alongside antibiotic prescribing. Through this, we aim to provide valuable insights into the effectiveness and cost-effectiveness of a broader point-of-care testing strategy in the context of respiratory infections, addressing the shortcomings of previous studies.

Patient Recruitment and Progress Update

Launched in December 2021 with a goal of enlisting 2500 participants, the trial has successfully recruited 2159 patients, achieving over 86% of its target, with primary care currently at 2006 patients and long-term care at 153 patients. The teams in Georgia, Greece, Ireland and the UK have reached their network recruitment target already. Recruitment progress typically exhibits a seasonal trend, with a drop-off during Summer months. The trial includes a sampling sub-study, currently underway in long-term care and soon to be rolled out in Primary Care in the UK and Georgia. Despite challenges, including the impact of COVID-19 regulations and varying symptom presentations, the long-term care facility network is evolving positively. Trial recruitment will end in January.

The ADEQUATE trial aims to assess antibiotic prescription practices and hospitalization outcomes in pediatric emergency departments across Europe. The trial employs randomization to standard care and intervention arms, with patients presenting with lower respiratory tract infections. In the intervention arm, the Biofire respiratory panel assay is utilized, offering rapid testing for 24 pathogens, aiding clinical decisions without prescribing specific guidelines. The primary endpoints include antibiotic prescription rates and hospitalization duration, with a focus on generating immediately applicable evidence for routine settings.

Patient Recruitment and Progress Update

Six out of seven sites have been activated and have recruited patients, with the site in Thessaloniki, Greece being the top recruiter and have already reached its recruitment target. Currently at 85% recruitment, the trial plans to reach its goal of 520 participants. Recruitment fluctuations, influenced by seasonal patterns and the impact of the COVID-19 pandemic, are taken into account. The trial anticipates a surge in enrollment during the upcoming winter season, with a projected closure of all sites by February to March 2024.