Point-of-care testing in community pharmacies to improve antimicrobial stewardship in respiratory infections: a scoping review of effectiveness, implementation and cost-effectiveness.

OBJECTIVE

To explore evidence on effectiveness, feasibility, cost-effectiveness and implementation factors of point-of-care testing (PoCT) in community pharmacies for antimicrobial stewardship in respiratory tract infections (RTIs).

METHODOLOGY: A systematic scoping review of PoCT studies published between 1 January 2012 and 30 July 2025 included randomized and non-randomized trials, health economic evaluations, post-implementation surveys and qualitative studies. Study quality was assessed using critical appraisal tools. Quantitative outcomes were summarized descriptively, and implementation factors were mapped using the Consolidated Framework for Implementation Research.

RESULTS

Twenty-seven of 2689 studies were included; all but one were from high-income countries. Non-comparative studies suggested that PoCT reduced antibiotic supply. In C-reactive protein (CRP)-PoCT studies (n = 3; 503 patients), a median of 79.5% (IQR 72.2%-85.4%) had CRP <20 mg/L, indicating no need for antibiotics, while 1.2% (IQR 0%-11.3%) had CRP >100 mg/L, suggesting antibiotics were required; 12% were referred to general practitioners. In Group A Streptococcus (GAS)-PoCT studies (n = 12; 53 918 patients), 24.9% (IQR 17.8%-28.5%) tested positive and 21.3% (IQR 16.8%-27%) received antibiotics. In influenza-PoCT studies (n = 5; 374 patients), 34% (IQR 19.8%-36.1%) tested positive and 25.5% (IQR 10.1%-31.8%) received antivirals. Limited health economic evidence suggested that GAS-PoCT may be cost saving or cost minimizing. Thirteen interventions were identified to improve PoCT adoption.

CONCLUSION

PoCT is feasible in community pharmacies to improve antimicrobial stewardship in RTIs. Successful uptake requires context-specific strategies, such as pharmacist training, collaboration with general practitioners and the implementation of appropriate reimbursement models. High-quality randomized trials are needed to confirm effectiveness and cost-effectiveness of pharmacy-led PoCT for policy implementation.