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Ann Transl Med. 2017 May;5(10):208. doi: 10.21037/atm.2017.04.04.

Biomarker-guided antibiotic therapy-strengths and limitations.

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Intensive Care Unit, Hospital de Vila Franca de Xira, Vila Franca de Xira, Portugal.
NOVA Medical School, New University of Lisbon, Lisbon, Portugal.
D'Or Institute for Research and Education, Rio de Janeiro, Brazil.
St. James's University Hospital, Trinity Centre for Health Sciences, Dublin, Ireland.
Irish Center for Vascular Biology, Dublin, Ireland.
Polyvalent Intensive Care Unit, Hospital de São Francisco Xavier, Lisbon, Portugal.


Biomarkers as C-reactive protein (CRP) and procalcitonin (PCT) emerged as tools to help clinicians to diagnose infection and to properly initiate and define the duration of antibiotic therapy. Several randomized controlled trials, including adult critically ill patients, showed that PCT-guided antibiotic stewardship was repeatedly associated with a decrease in the duration of antibiotic therapy with no apparent harm. There are however some relevant limitations in these trials namely the low rate of compliance of PCT-guided algorithms, the high rate of exclusion (without including common clinical situations and pathogens) and the long duration of antibiotic therapy in control groups. Such limitations weakened the real impact of such algorithms in the clinical decision-making process and strengthened the concept that the initiation and the duration of antibiotic therapy cannot depend solely on a biomarker. Future efforts should address these limitations in order to better clarify the role of biomarkers on the complex and multifactorial issue of antibiotic management and to deeply understand its potential effect on mortality.


Biomarkers; C-reactive protein (CRP); antibiotic; infection; procalcitonin (PCT)

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Conflicts of Interest: The authors have no conflicts of interest to declare.

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