http://annals.org/ en-us Tue, 19 Feb 2013 00:00:00 GMT Tue, 09 Apr 2013 13:47:56 GMT Silverchair editor@annals.org webmaster@annals.org http://annals.org/article.aspx?articleID=1584278 Tue, 19 Feb 2013 00:00:00 GMT Jagminas L. <span class="paragraphSection"><div class="boxTitle">Question</div>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)?<div class="boxTitle">Review scope</div>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.<div class="boxTitle">Review methods</div>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 (<span style="font-style:italic;">n</span> = 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.<div class="boxTitle">Main results</div>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, <span style="font-style:italic;">P</span> < 0.001).<div class="boxTitle">Conclusion</div>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*OutcomesNumber of trials (<span style="font-style:italic;">n</span>)Weighted event ratesAt ≤ 1 monthPCT-guidedUsual careRRR (95% CI)NNT (CI)Treatment failure14 (4211)19%22%15% (2 to 24)32 (19 to 194)Mortality14 (4211)5.9%6.3%6% (−21 to 28)Not significant*Abbreviations defined in Glossary. RRR, NNT, and CI calculated from control event rates and adjusted odds ratios in article.</span> http://annals.org/article.aspx?articleID=1584278