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ACS Infect Dis. 2017 Dec 8;3(12):875-879. doi: 10.1021/acsinfecdis.7b00199. Epub 2017 Nov 9.

Management of Respiratory Infections with Use of Procalcitonin: Moving toward More Personalized Antibiotic Treatment Decisions.

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Medical University Department, Kantonsspital Aarau , Tellstrasse, 5000 Aarau, Switzerland.
Faculty of Medicine, University of Basel , Petersplatz, 4031 Basel, Switzerland.
National Institute of Allergy and Infectious Diseases Respiratory Pathogen Research Center, University of Rochester Medical Center , 601 Elmwood Ave., Rochester, New York 14642, United States.
Service de Réanimation Médicale, Université Paris 7-Denis-Diderot , 5 Rue Thomas Mann, 75013 Paris, France.
Department of Pulmonary Medicine, Medizinische Hochschule Hannover , Carl-Neuberg-Straße 1, 30625 Hannover, Germany.
Department of Intensive Care, Hospital das Clinicas da Universidade Federal de Minas Gerais , 110 Santa Efigênia, Belo Horizonte, Minas Gerais 30130-100, Brasil.
Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital , Am Klinikum 1, 07747 Jena, Germany.
Department of General Intensive Care, University Hospital of Liege, domaine universitaire du Sart Tilman, , 4000 Liège, Belgium.
Intensive Care Center, Medisch Spectrum Twente, Koningsplein 1, 7512KZ, Enschede, The Netherlands.
Critical Care Unit, Hospital Israelita Albert Einstein , Av. Albert Einstein, 627/701, Morumbi, São Paulo, São Paulo 05652-900, Brazil.
Critical Care and Peri-operative Medicine, Monash Health , Clayton Rd., Clayton, Victoria 3171, Australia.
School of Clinical Sciences, Monash University , E Block, Level 5, Monash Medical Centre, Clayton, Victoria 3168, Australia.
CHIP & PERSIMUNE, Department of Infectious Diseases, Finsencentret, Rigshospitalet, University of Copenhagen , Blegdamsvej 9, 2100 København, Denmark.
Department of Internal Medicine, Respiratory Medicine, Herlev & Gentofte Hospital , Niels Andersens Vej 28, 2900 Hellerup, Denmark.


Due to overlap of clinical findings and low sensitivity of bacterial diagnostic tests, differentiation between bacterial and viral respiratory tract infections remains challenging, ultimately leading to antibiotic overuse in this population of patients. Addition of procalcitonin, a blood biomarker expressed by epithelial cells in response to bacterial infections, to the clinical assessment leads to a reduction in inappropriate antibiotic initiation. Procalcitonin also provides prognostic information about the resolution of illness, and significant decreases over time are a strong signal for the discontinuation of antibiotics. Current evidence from randomized trials indicates that procalcitonin-guided antibiotic stewardship results in a reduction in antibiotic use and antibiotic side effects, which importantly translates into improved survival of patients with respiratory infections. Inclusion of procalcitonin into antibiotic stewardship algorithms thus improves the diagnostic and therapeutic management of patients presenting with respiratory illnesses and holds great promise to mitigate the global bacterial resistance crisis.

[Indexed for MEDLINE]

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