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31-08-2011 | General practice | Article

Procalcitonin levels show promise for guiding antibiotic therapy

Abstract

Free abstract

MedWire News: Clinical algorithms based on procalcitonin (PCT) levels are useful for guiding decisions about antibiotic therapy, helping to reduce antibiotic overuse without jeopardizing patient health, say researchers.

Writing in the Archives of Internal Medicine, they propose specific procalcitonin algorithms for low-, moderate-, and high-acuity patients as a basis for future trials aimed at reducing antibiotic use.

Philipp Schuetz (Harvard School of Public Health, Boston, Massachusetts, USA) and team conducted a systematic overview of previous randomized controlled trials of PCT algorithms for antibiotic treatment decisions.

In all, they identified 14 such trials involving 4467 adult patients with respiratory tract infections or sepsis across a range of healthcare settings (primary care, emergency department, and intensive care).

In each trial, participants were randomly assigned to have their treatment guided either by the use of a PCT algorithm or to usual care (control).

The data were extracted, graded for quality, and synthesized to give pooled odds ratios (OR) for the endpoint of all-cause mortality.

There was no significant difference in mortality between PCT and control patients either overall (OR=0.91) or in primary care (OR=0.13), emergency department (OR=0.95), and intensive care (OR=0.89).

Furthermore, the use of PCT algorithms was consistently associated with less antibiotic use and/or duration of therapy in low-acuity primary care and emergency-department patients, and with a shorter duration of therapy in moderate- and high-acuity emergency department and intensive care patients.

Taken together, these observations suggest that the use of PCT to guide antibiotic decisions appears to reduce antibiotic exposure without worsening the mortality rate, say the authors.

Based on their findings, Schuetz et al propose three separate algorithms depending on the patient's probability of contracting a bacterial infection: low risk/low acuity (eg, patients with nonpneumonic upper and lower respiratory tract infection treated in primary care); moderate risk/moderate acuity (eg, patients who are clinically stable in the emergency department or hospitalized with pneumonia); and high risk/high acuity (eg, patients in intensive care or with suspected sepsis).

"The use of PCT-guided algorithms for antibiotic therapy decisions… appears to be effective at reducing use of antibiotics without sacrificing patient safety," they conclude.

"Based on the available evidence, we have proposed PCT algorithms based on clinical acuity levels, which should be used in future large multicenter trials within the USA, powered for patient outcomes and aimed at reducing antibiotic overconsumption."

By Joanna Lyford

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