Support for procalcitonin testing to help control antibiotic prescribing
medwireNews: Measurement of procalcitonin to guide antibiotic treatment in patients with respiratory tract infections can reduce antibiotic exposure without risking any increase in treatment failure or all-cause mortality, US researchers report in JAMA.
Their findings held true across a range of severity of respiratory infections.
Procalcitonin algorithms used in this way could help to limit antibiotic overuse and consequently help control emergence of antibiotic resistance and the risk for Clostridium difficile infection.
The researchers, led by Philipp Schuetz (Kantonsspital Aarau, Switzerland), studied the safety and efficacy of procalcitonin algorithms in guiding antibiotic prescription by analyzing 14 trials spanning 2004-2011. These studies included a total of 4211 patients (average age 59.8 years) with respiratory infections including bronchitis, exacerbation of chronic obstructive pulmonary disease (COPD), community-acquired pneumonia (CAP), and ventilator-associated pneumonia.
The algorithms recommend antibiotic prescription initiation and cessation based on elevations and subsequent normalization of procalcitonin - a biomarker for bacterial infections that is released in response to bacterial toxins and bacteria-specific proinflammatory mediators.
The analysis revealed that there was no increase in all-cause mortality when procalcitonin was used to guide antibiotic treatment compared with when no guidance was used. This was true overall and across every clinical setting and type of respiratory infection, namely in primary care, the intensive care unit, the emergency department, in patients with CAP, and in those with COPD exacerbation.
Furthermore, there was no increase in treatment failure with procalcitonin-guided antibiotic use in any setting or infection type, and for patients treated in the emergency department and those with CAP the odds for treatment failure was actually lowered in the procalcitonin group, by 13% and 14%, respectively.
Moreover, patients with measurement of procalcitonin had reduced antibiotic exposure. For patients treated in primary care, median exposure in the procalcitonin group was 1 day versus 6 days in the control group.
"The lower risk of treatment failure associated with procalcitonin testing may in part relate to lower antibiotic exposure, but this needs further exploration," the authors note.
Schuetz and team conclude that "future trials should evaluate the cost-effectiveness of procalcitonin algorithms by considering country-specific costs of procalcitonin measurements and potential savings and health benefits by reducing antibiotic prescription rates."
By Caroline Price, Senior medwireNews Reporter