Pilot study evaluates molecular POCT for Streptococcus pyogenes in children

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medRxiv Published April 22, 2026 Medically reviewed April 25, 2026 Study authors: Mills, E. A.; Bingham, R.; Nijman, R. G.; Sriskandan, S. DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Consider that this pilot study suggests POCT could reduce antibiotic use but is not approved for clinical use.

This is a pilot research study conducted in a West London paediatric emergency department. The scope was to evaluate a molecular point-of-care test (POCT) on a second research throat swab for Streptococcus pyogenes in children under 16 years, while clinical management was based on conventional culture swabs.

The authors synthesized findings from 49 participants. Swab positivity in symptomatic children was 12.8% (6/47). Antibiotic use was frequent, with 38/49 (77.6%) participants receiving antibiotics; of those recommended to receive antibiotics, 29/38 (76.3%) had a negative POCT. Time to reporting of positive throat swab culture results was a mean of 3.67 days (range 3-5 days), while POCT results were available within minutes.

Key limitations noted by the authors include the low prevalence of streptococcal infection during the study period (May 2023-June 2025), that the molecular POCT was not approved for use in the host NHS Trust, and that clinical management was unaffected by the research swab result.

The authors suggest that POCT could avoid or stop antibiotic use in over three-quarters of children in the ED if suspicion of S. pyogenes is the main driver for prescribing. However, this is a pilot study with a small sample size, and the findings should be interpreted with caution.

Study Details

EvidenceLevel 5

PublishedApr 2026

View Original Abstract ↓

Background An upsurge in Streptococcus pyogenes infections 2022-2023 highlighted potential benefits of point-of-care tests (POCT) to support clinical pathways, prevent outbreaks, and optimise antibiotic use. Objectives We conducted a pilot research study in a west London paediatric emergency department (ED) to determine whether a molecular POCT had potential to alter management in children who were also having a conventional throat swab taken for culture. Methods Children <16 years presenting to ED who had a throat swab requested by a clinician were invited to have a second swab taken for research purposes only. Clinical management was unaffected by the research swab result, which was processed using a molecular POCT that was not approved for use in the host NHS Trust. Results Prevalence of streptococcal infection was low during the study (May 2023-June 2025); swab positivity in symptomatic children was 12.8% (6/47). Overall, 38/49 (77.6%) participants who had throat swabs received antibiotics. Of those children recommended to receive antibiotics, 29/38 (76.3%) had a negative POCT. Mean time to reporting of positive throat swab culture results was 3.67 days (range 3-5 days) leading to occasional delay in treatment, although POCT identified positive results within minutes. Conclusion Antibiotic use was frequent and could be avoided or stopped by use of a rule out POCT in over three-quarters of children in the ED, if suspicion of S. pyogenes is the main driver for prescribing. POCT were easy to process and produced immediate results compared with culture, in theory enabling timely decision-making and avoiding treatment delay.