Procalcitonin to Guide Initiation and Duration of Antibiotic Treatment in Acute Respiratory Infections: An Individual Patient Data Meta-Analysis

Abstract

This individual patient data meta-analysis of clinical trials investigating procalcitonin algorithms for antibiotic decision making found no increased risk of death or setting-specific treatment failure but did find significantly lower antibiotic exposure across different acute respiratory infections and clinical settings.

Economic evaluation of procalcitonin-guided antibiotic therapy in acute respiratory infections: a US health system perspective

“…Biomarkers have shown to be very effective in aiding diagnosis and management of hospital patients with suspected systemic bacterial infections, including community-acquired pneumonia (CAP) and sepsis [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. Procalcitonin (PCT) is a novel and effective marker of assumed bacterial infections that safely helps guide antibiotic therapy in acute respiratory tract infections (ARI) and sepsis in hospitals [5,[29][30][31][32][33][34][35][36][37][38][39][40].…”

“…The use of PCT supplies caregivers with added information, which, in principle, enables them to improve the selection of patients for treatment, the timing of treatment initiation, and the overall duration of treatment [21,28,32,33,35,[41][42][43][44][45][46][47]. Insofar as caregivers change their care management and treatment strategies in response to the new information (relative to the usual standard course of action), there are implications for changes in outcomes, both in terms of treatment costs and health status [14,33,35].…”

“…Insofar as caregivers change their care management and treatment strategies in response to the new information (relative to the usual standard course of action), there are implications for changes in outcomes, both in terms of treatment costs and health status [14,33,35].…”

“…There is strong evidence that PCT-guided care management results in reductions in antibiotic exposure and possibly costs [33,35,37,38,[48][49][50][51][52][53]. For example, a comparative effectiveness summary report from the US Agency for Healthcare Research and Quality ("AHRQ"; 2012) concluded that there was high strength of evidence in support of PCT reducing antibiotic usage, with relative reductions ranging from 21% to 38% [53].…”

“…Recently, performed a meta-analysis of patient-level data from 4221 adults with ARIs from 14 clinical trials [33]. In addition to a marked reduction in antibiotic exposure, they found significant differences in treatment failure (defined as "death, hospitalization, ARI-specific complications, recurrent or worsening infection, and discomfort at 30 days") overall between the PCT group and the control group (19.1% and 21.9%, respectively).…”