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

Abstract：

INTRODUCTION: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.

journal_name

Expert Rev Anti Infect Ther

journal_title

Expert review of anti-infective therapy

authors

Schuetz P,Bolliger R,Merker M,Christ-Crain M,Stolz D,Tamm M,Luyt CE,Wolff M,Schroeder S,Nobre V,Reinhart K,Branche A,Damas P,Nijsten M,Deliberato RO,Verduri A,Beghé B,Cao B,Shehabi Y,Jensen JS,Beishuizen A,de Jo

doi

10.1080/14787210.2018.1496331

subject

Has Abstract

pub_date

2018-07-01 00:00:00

pages

555-564

issue

eissn

1478-7210

issn

1744-8336

journal_volume

pub_type

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