Project funded to accelerate testing for respiratory infections

24 November 2025

The study will evaluate a rapid diagnostic tool to which can distinguish between bacterial and viral infections.

Led by Professor Jethro Herberg, with partners in the MRC Unit The Gambia, the study will evaluate a rapid lateral flow device and app to confirm that these tools are accurate and effective in settings where there is high antimicrobial resistance.

Accurate diagnosis will help clinicians understand the underlying cause of illness, allowing people with bacterial infections to receive faster treatment. At the same time, using the test could reduce unnecessary treatment with antibiotics for viral cases, which is one of the leading drivers of antimicrobial resistant infections.

A major driver of antimicrobial resistance is the unnecessary use of antibiotics in those who don’t need them. By accurately finding out who has a bacterial infection and viral infection, we can ensure we only use antibiotics in those patients who need them Professor Jethro Herberg Department of Infectious Disease

The new diagnosis tool, which is in the prototype phase, shows results within 10 minutes, can be produced cheaply, and does not require substantial healthcare infrastructure or processing. Currently, the device will be piloted in children with lower respiratory tract infections, which are serious infections of the airways, including conditions like bronchitis and pneumonia.

Professor Jethro Herberg said: “Lateral flow tests are rapid and easily accessible, making them suitable for use in all environments, including communities where there is little health infrastructure. A major driver of antimicrobial resistance is the unnecessary use of antibiotics in those who don’t need them. By accurately finding out who has a bacterial infection and viral infection, we can ensure we only use antibiotics in those patients who need them – and reduce the number of patients taking them, whilst ensuring those patients with bacterial infections still get the right treatment promptly.”

Unmasking infection: bacteria or virus?

The human immune system responds differently to bacterial and viral infections. Previous studies by Professor Herberg’s team identified five biomarkers that can indicate whether a person’s symptoms are caused by a bacterial or viral infection. This discovery laid the foundation for developing the test.

The test, called Marple, is a lateral flow device paired with a smartphone app that detects whether the five markers are present. Using an algorithm, the app determines whether an infection is caused by bacteria or viruses.

Discovering the cause of lower respiratory tract infections quickly is challenging because the symptoms can appear the same. In regions such as The Gambia, people who display the symptoms of a respiratory tract infection are often prescribed antibiotics as a first-line treatment, even when the infection may be viral.

The study will launch a pilot test in both the NHS and The Gambia, as in both settings, identifying the cause of infection remains a significant challenge. The research will assess whether Marple is accurate and effective in test populations before scaling up into further studies.

Combatting antimicrobial resistance

This new test is expected to be one of the many tools that are used to determine the differences between bacterial and viral infections – a key step in tackling antimicrobial resistance.

The work has been funded by PACE (Pathways to Antimicrobial Clinical Efficacy), which is a £30 million initiative supporting early-stage innovation in medicines and diagnostics to tackle antimicrobial resistance (AMR) and save lives. It is a collaboration between Innovate UK, LifeArc, and Medicines Discovery Catapult – three leaders in the UK's health innovation and research community with unique expertise harnessed by catalysing and working with the global AMR community to accelerate the speed of innovation and mitigate the risk of AMR.

Speaking about the award funding, Professor Jethro Herberg said, “The award of PACE funding to develop a lateral flow test that discriminates bacterial and viral infection in children is a watershed moment for our team. After 15 years of research to discover and develop new approaches to diagnose common causes of fever, now is an exciting moment in the journey, as we bring a novel test platform back to our patients. With PACE funding, we will test a lateral flow device that aims to bring rapid, accurate, affordable diagnosis to children in both high- and low-income settings.”