Keywords: Primary care, Lung point-of-care ultrasound (POCUS), Acute respiratory tract infections, Antibiotic prescribing, Clinical decision-making

Background:

Acute respiratory tract infections are among the most frequent reasons for consultations in primary care and represent a major driver of antibiotic prescribing in the community, often in the absence of clear bacterial indications. This practice substantially contributes to antimicrobial resistance. Maccabi Health Services has trained and supplied US devices to hundreds of primary care clinicians over the past five years, in light of evidence that Lung POCUS is a safe and accurate diagnostic tool for the assessment of pulmonary pathology. However, its real-world impact on clinical decision-making and antibiotic prescribing patterns in primary care—particularly in mixed adult and pediatric populations—remains uncertain.

Research questions:

Primary:
Is the use of lung POCUS by primary care physicians associated with a reduction in antibiotic prescribing for acute respiratory tract infections in adults and children?
Secondary:
How are physician-related factors (specialty, level of training, years of experience, and POCUS proficiency) associated with antibiotic prescribing behavior among clinicians who perform lung POCUS?
What patient characteristics and clinical diagnoses are associated with the decision to perform lung POCUS in primary care settings?
Does the use of lung POCUS reduce referrals for chest radiography in patients with acute respiratory tract infections?

Method:

This retrospective cross-sectional study will use electronic medical record data from Maccabi Healthcare Services (2020–2025). Adult and pediatric patients with acute respiratory tract infections who underwent lung POCUS during a primary care visit will be included and matched 1:2 with patients who did not undergo POCUS by age, sex, and diagnosis. Outcomes will include antibiotic prescribing at the index visit and within 7 days and referral for chest radiography. Physician characteristics (specialty, training level, experience, and POCUS proficiency) will be analyzed. Associations between lung POCUS use and outcomes will be assessed using multivariable logistic regression adjusted for relevant clinical and demographic confounders.

Results:

Conclusions:

Points for discussion:

Does lung POCUS change antibiotic prescribing decisions in primary care, or does it mainly reinforce decisions clinicians have already made?

How can lung POCUS be optimally integrated into primary care practice and training to support safe and rational antibiotic prescribing?