New Testing Technology Cuts Unnecessary Antibiotic Use in Children, Local Study Finds

The introduction of advanced diagnostic testing at Glendon Hospital has led to a sharp decline in unnecessary antibiotic prescriptions for children with respiratory infections, according to new research presented by Dr Tiffannie Skerritt-Flemming.

Dr Skerritt-Flemming, who recently completed a master’s degree in paediatric emergency medicine, shared findings from her study at the Ministry of Health and Social Services’ annual Research Day. The research compared children treated for acute respiratory infections (ARI) before and after the hospital gained access to a new molecular testing platform known as the BioFire machine in 2023.

“Respiratory infections are one of the most common reasons children are brought to casualty. The temptation, when you see a fever and a cough, is to prescribe antibiotics,” Dr Skerritt-Flemming explained. “But the vast majority of these infections are caused by viruses, not bacteria, so antibiotics don’t help. With better testing, we can make better choices.”

Measuring the Impact

The study analysed 424 cases of children who presented to casualty between 2022 and 2024. Using laboratory records, triage notes and admission logs, researchers compared outcomes before and after the new testing was introduced.

Key findings included:

• Antibiotic prescribing dropped by nearly half from 21% of cases before the new testing was available, to 12.8% afterwards.
• Admissions remained unchanged, suggesting that while testing reduced unnecessary prescriptions, it did not affect the number of children requiring hospital observation or treatment.
• Young children were most affected, those under five were both the most likely to present with infections and the most likely to be prescribed antibiotics.

The BioFire test, which uses PCR technology, can detect multiple respiratory viruses and bacteria within hours. In Montserrat, the most common pathogen identified was rhinovirus, responsible for about half of positive swabs, followed by coronaviruses and other seasonal viruses.

“When we actually swabbed children and had a confirmed diagnosis, only 10% were given antibiotics,” Dr Skerritt-Flemming noted. “That shows how powerful accurate testing can be in guiding treatment.”

Why It Matters

Globally, the overuse of antibiotics is a major public health concern, fuelling antimicrobial resistance (AMR) and rendering once-effective drugs useless. Children are particularly at risk of being overprescribed antibiotics for viral illnesses such as colds, influenza, and bronchiolitis.

Dr Skerritt-Flemming emphasised that reducing unnecessary prescriptions is about both safety and sustainability. “There are side effects, There are adverse effects. There are allergies, etcetera. And because of the growing concerns with anti antimicrobial resistance, we want to conserve, we want to reduce the quantities of antibiotics being prescribed.”

Challenges and Limitations

The study faced hurdles with small sample sizes and incomplete data, especially from older triage books. Dr Skerritt-Flemming highlighted the need for consistent diagnosis recording and welcomed the roll-out of Montserrat’s new electronic health information system, which will allow for better tracking.

She also cautioned parents that testing is not performed on every child due to the high cost, estimated at over US$100 per test. “Swabs are done strategically, often when there is a surge in cases, so we can identify what’s circulating. Once we know, we can treat accordingly,” she explained.

Next Steps

While the study did not find a significant change in hospital admissions, Dr Skerritt-Flemming said further monitoring with larger datasets could reveal longer-term impacts. For now, the focus is on sustaining the positive reduction in antibiotic use.

“We continue to perform our weekly surveillance for acute respiratory infections and collect data that is important and this will help to guide and improve the work that we are doing through the department,” she concluded.