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Expert Rev Anti Infect Ther. 2018 Jul;16(7):555-564. doi: 10.1080/14787210.2018.1496331. Epub 2018 Jul 13.

Procalcitonin-guided antibiotic therapy algorithms for different types of acute respiratory infections based on previous trials.

Author information

1
a Faculty of Medicine , University of Basel , Basel , Switzerland.
2
b Medical University Department , Kantonsspital Aarau , Aarau , Switzerland.
3
c Division of Endocrinology, Diabetology and Clinical Nutrition , University Hospital Basel , Basel , Switzerland.
4
d Clinic of Pneumology and Pulmonary Cell Research , University Hospital Basel , Basel , Switzerland.
5
e Service de Réanimation Médicale , Université Paris 6-Pierre-et-Marie-Curie , Paris , France.
6
f Service de Réanimation Médicale , Université Paris 7-Denis-Diderot , Paris , France.
7
g Department of Anaesthesiology and Intensive Care Medicine , Krankenhaus Dueren , Dueren , Germany.
8
h Department of Intensive Care , Hospital das Clinicas da Universidade Federal de Minas Gerais , Belo Horizonte , Brazil.
9
i Department of Anaesthesiology and Intensive Care Medicine , Jena University Hospital , Jena , Germany.
10
j National Institute of Allergy and Infectious Diseases Respiratory Pathogen Research Center , University of Rochester Medical Center , Rochester , NY , USA.
11
k Department of General Intensive Care , University Hospital of Liege, Domaine universitaire de Liège , Liege , Belgium.
12
l University Medical Centre , University of Groningen , Groningen , Netherlands.
13
m Critical Care Unit , Hospital Israelita Albert Einstein , São Paulo , Brazil.
14
n Section of Respiratory Medicine, Department of Medical and Surgical Sciences , University Polyclinic of Modena, University of Modena and Reggio Emilia , Modena , Italy.
15
o Center for Respiratory Diseases;Department of Pulmonary and Critical Care Medicine , China-Japan Friendship Hospital , Beijing , China.
16
p School of Clinical Sciences, Faculty of Medicine Nursing and Health Sciences , Monash University , Melbourne , Australia.
17
q Critical Care and Peri-operative Medicine , Monash Health , Melbourne , Australia.
18
r CHIP & PERSIMUNE, Department of Infectious Diseases , Rigshospitalet, University of Copenhagen , Copenhagen , Denmark.
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s Department of Internal Medicine, Respiratory Medicine Section , Herlev-Gentofte Hospital , Hellerup , Denmark.
20
t Department of Intensive Care , Medisch Spectrum Twente , Enschede , the Netherlands.
21
u Department of Intensive Care , VUmc University Medical Center , Amsterdam , the Netherlands.
22
v Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research , University Hospital Basel , Basel , Switzerland.
23
w Department of Pulmonary Medicine , Medizinische Hochschule Hannover , Hannover , Germany.

Abstract

Although evidence indicates that use of procalcitonin to guide antibiotic decisions for the treatment of acute respiratory infections (ARI) decreases antibiotic consumption and improves clinical outcomes, algorithms used within studies had differences in PCT cut-off points and frequency of testing. We therefore analyzed studies evaluating procalcitonin-guided antibiotic therapy and propose consensus algorithms for different respiratory infection types. Areas covered: We systematically searched randomized-controlled trials (search strategy updated on February 2018) on procalcitonin-guided antibiotic therapy of ARI in adults using a pre-specified Cochrane protocol and analyzed algorithms from 32 trials that included 10,285 patients treated in primary care settings, emergency departments (ED), and intensive care units (ICU). We derived consensus algorithms for use of procalcitonin by the type of ARI including community-acquired pneumonia, bronchitis, chronic obstructive pulmonary disease or asthma exacerbation, sepsis, and post-operative sepsis due to respiratory infection. Consensus algorithm recommendations differ with regard to timing of treatment (i.e. timing of initiation in low-risk patients or discontinuation in high-risk patients) and procalcitonin cut-off points for the recommendation/strong recommendation to discontinue antibiotics (≤ 0.25/≤ 0.1 µg/L in ED and inpatients, ≤ 0.5/≤ 0.25 µg/L in ICU patients, and reduction by ≥ 80% from peak levels in sepsis patients). Expert commentary: Our proposed algorithms may facilitate safe and efficient implementation of procalcitonin-guided antibiotic protocols in diverse healthcare settings. Still, the decision about initiation and cessation of antibiotic treatment remains a clinical decision based on the patient assessment and the severity of illness and use of procalcitonin should not delay empirical treatment in high risk situations.

KEYWORDS:

Procalcitonin; antibiotic stewardship; pneumonia; respiratory infection; systematic review

PMID:
29969320
DOI:
10.1080/14787210.2018.1496331
[Indexed for MEDLINE]

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