Could Procalcitonin Measurements Lessen Antibiotic Use for Respiratory Infections?

Guiding antibiotic use through measurements of procalcitonin—a biomarker that can be used in the diagnosis of bacterial infections—likely does not decrease use of antibiotics among patients with suspected lower respiratory tract infection, according to a new study.

For their study, the researchers assessed 1656 patients in 14 US hospitals with high adherence to quality measures for the treatment of pneumonia.
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All patients included in the study had presented to the emergency department with a suspected lower respiratory tract infection, and treating physicians were unsure whether antibiotic therapy was needed.

Each patient was randomly assigned to either the procalcitonin group (n = 826)—which involved assessment of procalcitonin assay results and a guideline for antibiotic use with graded recommendations based on 4 tiers of procalcitonin levels—or the usual-care group (n = 830).

Ultimately, 782 (47.2%) patients were hospitalized, and 984 (59.4%) received antibiotics within 30 days. Procalcitonin assay results were provided for 792 (95.9%) patients in the procalcitonin group and for 18 (2.2%) patients in the usual care group.

Results of the study indicated that, although the procalcitonin-level tier was associated with the decision to prescribe antibiotics in the emergency department, there was no significant between-group difference in antibiotic days (4.2 days for procalcitonin group vs 4.3 days for usual care) or the proportion of patients with adverse outcomes (11.7% vs 13.1%) within 30 days.

“The provision of procalcitonin assay results, along with instructions on their interpretation, to emergency department and hospital-based clinicians did not result in less use of antibiotics than did usual care among patients with suspected lower respiratory tract infection,” the researchers concluded.

—Christina Vogt

Reference:

Huang DT, Yealy DM, Filbin MR, et al. Procalcitonin-guided use of antibiotics for lower respiratory tract infection [Published online May 20, 2018]. N Eng J Med. doi:10.1056/NEJMoa1802670