From Urgent Care to Smarter Care: Using Rapid Testing to Fight Antibiotic Resistance

Antibiotics have revolutionized medicine, saving countless lives by treating previously fatal bacterial infections with ease. Yet today, their power is in serious jeopardy. Every year in the United States, nearly 3 million people develop infections that no longer respond to common antibiotics, and more than 35,000 die as a result. If serious infectious complications such as Clostridioides difficile (“C. diff”) infections — often caused by antibiotic use — are factored in, the toll increases to nearly 48,000 per year.” Much of this crisis stems from a straightforward fact: Antibiotics are inappropriately overprescribed, especially in urgent care clinics and emergency rooms. In these settings, it can be challenging to determine at a glance whether a patient’s illness is bacterial (for which the right antibiotics are effective) or viral (for which they are never effective). Fortunately, a faster, more precise laboratory test called RT-PCR (reverse transcription polymerase chain reaction) is helping doctors make better treatment choices — and fight antibiotic resistance along the way. 

Why overprescribing matters to you 

Certain antibiotics are only effective against specific bacteria –– and rarely, if ever, against viruses. However, with colds, flu, sinus infections, and throat soreness all mixed in a busy clinic, distinguishing their source based on symptoms alone can be challenging. To play it safe — or sometimes to satisfy the patient’s expectation of a prescription — clinicians often give antibiotics “just in case.” Over time, conditions such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) have emerged from this practice. These “superbugs” are much harder — and sometimes nearly impossible — to treat. Every unnecessary prescription not only puts the individual patient at risk of drug side effects, but it also chips away at the system’s ability to fight bacterial diseases in the future.

How common is the problem? 

• In 2022, U.S. doctors wrote more than 236 million antibiotic prescriptions in outpatient settings (clinics, urgent care, and the emergency department), which account for about 80 to 90 percent of all antibiotics. 
• At least one in three of those prescriptions wasn’t needed. 
• Nearly 30 percent of those prescriptions were for higher-risk antibiotic categories—drugs that the World Health Organization says should be used sparingly (much less than 30 percent of the time) to slow resistance. 

That level of overuse drives up healthcare costs, fills hospitals with harder-to-treat infections, and places an unfair burden on patients and the clinicians that care for them. 

Enter multiplex PCR: A faster, accurate, comprehensive diagnostic strategy 

Initially developed in the 1980s, PCR (polymerase chain reaction) testing amplifies tiny fragments of an organism’s genetic material, allowing them to be detected in a patient sample. RT-PCR (reverse transcriptase PCR) adds a step that converts RNA (the genetic material in many viruses) into DNA, making it possible to detect a broad range of microbes, including both bacterial and viral species. Multiplex PCR is a process whereby a sample, from a given body site, is tested for a preset list of viruses and bacteria, based on the most common illness-causing organisms. 

Speed is the single most significant advantage. Traditional blood or sputum cultures can take days to yield results, but RT-PCR can provide results in a few hours or even minutes, thanks to newer technology. That rapid turnaround helps doctors know precisely what they’re treating before issuing a potentially inappropriate prescription. 

There are several other benefits of RT-PCR testing for infectious diseases

1. Targeted therapy: Instead of broad-spectrum antibiotics that try to kill “everything,” doctors can choose a precise antibiotic tailored to the organism in question (or decide no antibiotic is needed). 
2. Fewer unnecessary prescriptions: Studies show that when RT-PCR is available, antibiotic use drops — sometimes by nearly half — because clinicians feel more confident not prescribing an antibiotic. 
3. Lower healthcare costs: While the test itself has a cost, hospitals and clinics save money by avoiding expensive complications, repeat visits, readmissions, and the societal cost of resistant infections. 
4. Better outcomes: Patients get the proper treatment faster, recover sooner, and avoid the many side effects associated with inappropriate antibiotic treatment. A recent HealthTrackRx survey of over 700 providers found 98% believed RT-PCR improved patient outcomes, and nearly half reported patients expressed appreciation for a rapid and accurate diagnosis. 

When RT-PCR makes sense 

Not every sore throat or sniffle needs RT-PCR testing before a treatment decision is made. Clinicians can often use a stepwise approach to decide on testing: 

1. Initial evaluation: A doctor or nurse assesses symptoms, like fever, cough, and sore throat, and risk factors like age or chronic illnesses. 
2. Quick point-of-care testing: Simple, cost-effective tests (for strep throat or flu, for example) are done in the examining room to rule in or out common infections. 
3. RT-PCR testing: If the diagnosis remains unclear — especially in patients who are very sick, have recently taken antibiotics, or have other health issues — RT-PCR pinpoints the microbial culprit in hours. 

This sequence keeps costs and wait times reasonable while still giving access to advanced testing and appropriate treatment when it matters most. 

Reading the results carefully 

Our bodies naturally harbor many harmless bacteria and fungi. RT-PCR is so sensitive that it can pick up tiny amounts of these microbes that aren’t causing disease. For example, someone might carry a normal bacterium in their nose without it causing a sinus infection. To avoid treating these harmless “colonizers,” labs often report the quantity of a microbe they find in a sample. Higher levels may suggest an actual infection, while very low levels usually suggest a different etiology. Doctors use these clues, alongside a patient’s symptoms, to decide whether treatment is truly warranted. 

Overcoming practical hurdles 

The Covid-19 pandemic showed that RT-PCR can be rolled out quickly when needed, but it also highlighted some challenges that remain for routine use of this testing modality: 

• Training providers: Clinicians need guidance on interpreting results in everyday illnesses. 
• Workflow integration: Clinics must fit testing steps smoothly into busy schedules to avoid long wait times and delays in treatment when indicated. 
• Insurance coverage: Reimbursement policies sometimes lag innovative technologies, making it harder for clinicians to invest in helpful diagnostics. 

Patient education is equally important. When doctors explain that waiting for a precise test protects patients — and the community — from resistant infections, most people are understanding and supportive. 

Working together for a healthier future 

Antibiotic resistance is not a problem any single doctor, clinic, or hospital system can solve alone. It requires collaboration among: 

• Healthcare organizations, to adopt and fund new testing strategies. 
• Diagnostic companies, to keep improving speed and ease of use. 
• Policymakers and insurers, to update reimbursement policy so advanced tests are accessible. 
• Patients need to understand why an antibiotic isn’t always the best first step for their illness. 

By making RT-PCR testing a routine option in outpatient and urgent care settings — and by educating all stakeholders along the clinical continuum — we can significantly reduce unnecessary antibiotic use, protect the effective drugs we still have, and ensure that bacterial infections remain treatable for future generations. Antibiotics remain one of medicine’s greatest weapons in the fight against disease. With more innovative diagnostics and a shared commitment to use antibiotics wisely, we can extend their lifespan and safeguard public health for the future.

Photo: Cavan Images, Getty Images

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