Liudvikas Jagminas, MD, FACEP
What are the relative efficacy and safety of procalcitonin (PCT)-guided initiation and discontinuation of antibiotic therapy compared with usual care in adults with acute respiratory infection (ARI)?
Included studies compared PCT-based antibiotic therapy initiation or discontinuation strategies with a control group without knowledge of PCT level or use of alternative biomarkers in adults with ARIs. Outcomes were treatment failure and mortality. Secondary outcomes included antibiotic use.
Cochrane Central Register of Controlled Trials (Issue 2, 2011), which includes MEDLINE and EMBASE/Excerpta Medica (May 2011) and Acute Respiratory Infections Group Specialised Register (Jun 2011), was searched for randomized controlled trials (RCTs). Trials that exclusively focused on pediatric patients or used procalcitonin to escalate antibiotic therapy were excluded. 14 RCTs (n = 4211) met the inclusion criteria: 10 had adequate generation of the randomization sequence, 7 had adequate allocation concealment, and 5 had blinded outcome assessors. Follow-up varied from hospital discharge or 14 to 21 days to 1 month. Community-acquired pneumonia was the most common ARI diagnosis.
Adherence to algorithms varied from 47% to 91%. Individual patient data meta-analyses showed that PCT-guided antibiotic therapy reduced treatment failure but not mortality compared with usual care (Table). The PCT-guided group had less antibiotic exposure than the usual care group (median 4 vs 8 d, P < 0.001).
Procalcitonin-guided initiation and discontinuation of antibiotic therapy reduced treatment failure but not mortality compared with usual care in adults with acute respiratory infection.
Individual patient meta-analysis of procalcitonin (PCT)-guided antibiotic therapy vs usual care for acute respiratory tract infections in adults*
*Abbreviations defined in Glossary. RRR, NNT, and CI calculated from control event rates and adjusted odds ratios in article.
Jagminas L. Meta-analysis: Procalcitonin-guided antibiotic therapy reduces treatment failure in acute respiratory infection. Ann Intern Med. ;158:JC2–5. doi: 10.7326/0003-4819-158-4-201302190-02005
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Published: Ann Intern Med. 2013;158(4):JC2-5.
Emergency Medicine, Hospital Medicine, Infectious Disease, Pneumonia, Pulmonary/Critical Care.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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