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Randomized Controlled Trial
. 2025 Sep;32(9):975-984.
doi: 10.1111/acem.70031. Epub 2025 Apr 18.

Effect of host-protein test (TRAIL/IP-10/CRP) on antibiotic prescription and emergency department or urgent care center return visits: The JUNO pilot randomized controlled trial

Adam J Singer  1 , Judd E Hollander  2 , Efrat R Kean  2 , Hope Ring  3 , W Frank Peacock  4 , Karina M Soto-Ruiz  5 , Sergey Motov  6 , Joby Thoppil  7 , Phyllis Hendry  8 , Salim Halabi  9 , Andrew C Meltzer  10 , Gary F Headden  11 , Tal Brosh-Nissimov  12 , David Zeltser  13 , Chad M Cannon  3
Affiliations
Randomized Controlled Trial

Effect of host-protein test (TRAIL/IP-10/CRP) on antibiotic prescription and emergency department or urgent care center return visits: The JUNO pilot randomized controlled trial

Adam J Singer et al. Acad Emerg Med. 2025 Sep.

Abstract

Objectives: Determining etiology for adults with symptoms of lower respiratory tract infection (LRTI) is challenging. MeMed BV (MMBV), an FDA-cleared blood test, computationally integrates the levels of three host proteins to differentiate bacterial and viral infections. We evaluated MMBV's impact on safe antibiotic prescribing at emergency department/urgent care centers (ED/UC).

Methods: The JUNO randomized controlled trial (RCT; NCT05762302) was a prespecified pilot phase of the JUPITER RCT. JUNO enrolled adult ED/UC patients with LRTI symptoms and clinician's consideration for antibiotic treatment. Inclusion criteria were fever within 7 days and one of cough, sputum production, dyspnea, or auscultation abnormality. Exclusion criteria were prior antibiotic use or immunosuppression. Patients were randomized to standard care (SC) or SC plus MMBV arms. JUNO's primary objective was to assess antibiotic prescription rate in the SC arm; the secondary objective was to assess JUPITER's study design.

Results: Eleven centers randomized 260 patients, with 214 included (106 SC, 108 MMBV). Median (IQR) age was 40 (28-55.8) years, 57% were female, and 78.5% were enrolled at ED. Common symptoms were cough (93.0%) and chills (70.0%). Overall, antibiotic prescription rates were 30% (95% CI 22% to 40%) and 24% (95% CI 17% to 33%) in the SC arm versus the MMBV (absolute difference of -6% [95% CI -18% to 6%]). More antibiotics were given with bacterial MMBV scores (41% vs. 78%, absolute difference 37%, 95% CI 6% to 61%; n = 40) and less with viral MMBV scores (25% vs. 12%, absolute difference -13%, 95% CI -25% to 0%; n = 144) in the SC versus MMBV arms. There was no increase in ED/UC return visits (8% vs. 3%, difference -6%, 95% CI -12% to 1%) or hospitalizations (3% vs. 0%, difference -3%, 95% CI -7% to 1%) in the SC arm versus the MMBV arm.

Conclusions: JUNO demonstrated that JUPITER's design results in 30% antibiotic prescription rate in the SC arm. JUNO supports that MMBV optimizes antibiotic prescriptions without increasing return ED/UC visits or hospitalizations.

Keywords: antibiotics; bacterial; diagnostics; rapid host response test; viral.

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Conflict of interest statement

AJS—research grants from AstraZeneca, Brainbox, Spectral; consultant for AstraZeneca. CMC—research grants from Abbott, AstraZeneca, Brainbox, Roche, and MeMed. WFP—research grants from Abbott, Brainbox, CSL‐Vifor, Quidel, Roche, and Siemens; consultant for Abbott, Astra‐Zeneca, Biocogniv, Brainbox, Bristol Meyers Squibb, Janssen, Osler, Quidel, Roche, Siemens, Spinchip, and Werfen; stock/ownership interests in AseptiScope Inc., Brainbox Inc., Biocogniv, Inc., Braincheck Inc., Coagulo Inc., Comprehensive Research Associates LLC, Comprehensive Research Management Inc., Emergencies in Medicine LLC, Lucia Inc., Prevencio Inc., RCE Technologies, ROMTech, ScPharma, Trivirum Inc., and Upstream Inc. ACM—research grants from Abbott, AstraZeneca, Biomerieux, CDC, Hologic, MeMed, Vapotherm, and 1 Eq Inc.; consultant for Vapotherm and Biomerieux. TBN—received honoraria from Gilead, GSK, AstraZeneca, MSD, and Medison. The other authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
MMBV test results with recommendations and patient flow. (A) MMBV test results, their interpretation and an accompanying recommendation provided to clinicians. This was given to the clinician for patients randomized to the MMBV arm. (B) Patient flow. MMBV, MeMed BV; SC, standard care.
FIGURE 2
FIGURE 2
Impact of MMBV on antibiotic prescription and ED/UC return visit. Impact of MMBV on antibiotic prescription and on return ED/UC visit with or without hospitalization. The distribution of prescription rates and ED/UC return visits across MMBV scores: Patients with unnecessary antibiotic prescription (MMBV <35; left‐hand columns) and in patients with bacterial scores (MMBV >65; right‐hand columns). Two randomized patients missing MMBV scores (one in each arm) are omitted. MMBV, MeMed BV; SC, standard care; UC, urgent care center.
See this image and copyright information in PMC

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