Procalcitonin measurements for guiding antibiotic treatment in pediatric pneumonia

Abstract

In order to evaluate the use of an algorithm based on a procalcitonin (PCT) cut-off value as a means of guiding antibiotic therapy, 319 hospitalised children with uncomplicated community-acquired pneumonia (CAP) were randomised 1:1 to be treated on the basis of the algorithm or in accordance with standard guidelines. The children in the PCT group did not receive antibiotics if their PCT level upon admission was <0.25 ng/mL, and those receiving antibiotics from the time of admission were treated until their PCT level was ≥ 0.25 ng/mL. The final analysis was based on 155 patients in the PCT group and 155 in the control group. In comparison with the controls, the PCT group received significantly fewer antibiotic prescriptions (85.8% vs 100%; p < 0.05), were exposed to antibiotics for a shorter time (5.37 vs 10.96 days; p < 0.05), and experienced fewer antibiotic-related adverse events (3.9% vs 25.2%; p < 0.05), regardless of CAP severity. There was no significant between-group difference in recurrence of respiratory symptoms and new antibiotic prescription in the month following enrollment. The results of this first prospective study using a PCT cut-off value to guide antibiotic therapy for pediatric CAP showed that this approach can significantly reduce antibiotic use and antibiotic-related adverse events in children with uncomplicated disease. However, because the study included mainly children with mild to moderate CAP and the risk of the use of the algorithm-based approach was not validated in a relevant number of severe cases, further studies are needed before it can be used in routine clinical practice.

Procalcitonin and community-acquired pneumonia (CAP) in children

“…An Italian [24] study performed on 319 children (aged 1 month to 14 years; inpatients), used PCT measurements to guide antibiotic treatment choices. The study design implied that all patients were divided into two subgroups: a PCT-guided therapy group, and an evidence-based therapy group.…”

Contributions of Procalcitonin in the Treatment of Neonatal Late Onset Sepsis: A Prospective Observational Study

“…The study by Bouadma et al [9] found that the prescription of antimicrobials might be shortened by over 2 days, using the evolution of PCT during the course of major septicaemia in adults hospitalised in intensive care units. Similarly, antimicrobial therapy could be shortened by 5 days in the treatment of community-acquired lung infection in children [10]. Our study also showed that the duration of antimicrobial therapy for secondary sepsis in neonates could be shortened by 5 days by using the serum concentrations of PCT.…”

“…Consequently, the duration of antimicrobial therapy was shortened by >2 days on the basis of the evolution of serum PCT concentrations, without increases in morbidity and mortality. Similarly, in children, the evolution of PCT enabled a five day shortening of antimicrobial therapy in the treatment of community-acquired lung diseases [10]. The efficacy of PCT-guided decision making on the duration of antibiotic treatment has never been studied in secondary sepsis of the neonate.…”

Irrational Use of Antibiotics in Medicine: Crisis of Antibiotic Resistance and what We Can Do

“…Экспресс-тест для определения БГСА дает возмож-ность выявлять пациентов со стрептококковым фарин-готонзиллитом и проводить антибиотикотерапию при-цельно. Упомянутые выше биомаркеры бактериальных инфекций (С-реактивный белок и прокальцитонин) полезны для принятия решения о старте или прекраще-нии антибактериальной терапии, например для диффе-ренциальной диагностики вирусных и бактериальных пневмоний [27]. Однако, необходимы дополнительные исследования, чтобы использовать их в случаях других инфекций, в том числе в качестве надежного маркера безопасной отмены антибиотиков при инфекциях кро-вотока.…”