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Will Culture-Free Diagnostic and Resistance Screening Reach Brazilian Primary Care? A Perspective on Reducing Empirical Antibiotic Prescribing

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SciELO Preprints
DOI
10.1590/scielopreprints.12540

Worldwide, primary care physicians frequently prescribe antibiotics empirically due to the absence of rapid, reliable tests for pathogen identification and antimicrobial susceptibility or resistance gene screening. While this practice is often necessary, it may lead to inappropriate treatments, promote antimicrobial resistance (AMR), and delay patient recovery. In low- and middle-income countries (LMICs), infrastructural and resource limitations exacerbate this issue, making advanced diagnostic platforms such as matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) or next-generation sequencing (NGS) largely inaccessible for decentralized clinics. Even in many high-income countries, rapid antimicrobial susceptibility testing (AST) before antibiotic prescribing in primary care remains limited and mostly confined to pilot programs. Supported by AI-assisted literature synthesis, this article examines the technical feasibility and logistical challenges of introducing low-cost, culture-free diagnostic methods within Brazil’s Unified Health System (Sistema Único de Saúde, SUS), especially in underserved areas. Although immediate implementation is constrained by technological, economic, and logistical hurdles, initiating this dialogue is essential to monitor technological progress, guide pilot testing, build capacity, and promote evidence-based prescribing at basic care units (Unidades Básicas de Saúde, UBS) as soon as feasible. This perspective invites stakeholders to evaluate, adapt, and prepare for simplified diagnostic tools that can realistically support primary care once available.

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