Procalcitonin-Guided Antibiotic Therapy
Effects of Using Procalcitonin To Guide Antibiotic Therapy in Patients With RTIs in the Ambulatory Care or Hospital Setting (1 of 2)
Patient populations with respiratory tract infections (RTIs) included in this review were those with acute exacerbations of chronic obstructive pulmonary disease, community-acquired pneumonia, bronchitis, sinusitis, tonsillitis, or pharyngitis in the outpatient, emergency department, or hospital setting.
In the studies included in this review that used procalcitonin-based algorithms, physicians could consider other clinical information and over-ride algorithms based on their clinical judgment.
There was high-strength evidence that procalcitonin reduced duration of antibiotic use. Antibiotic duration was reported in seven studies. The duration of antibiotic therapy was reduced with procalcitonin-guided therapy in six of the seven studies, and the absolute reduction ranged from -1.0 to -7.1 days, with a relative reduction of -12.7 to -55 percent. The absolute reduction was statistically significant in four of the five studies for which p-values were either reported or calculated. A meta-analysis of the four studies found a statistically significant pooled mean difference of -2.35 days favoring procalcitonin (95-percent confidence interval [95% CI]: -4.38, -0.33).
There was high-strength evidence that procalcitonin reduced prescription rates for antibiotics. The antibiotic prescription rate was reported in all eight studies. An absolute reduction in antibiotic prescription rate was demonstrated with procalcitonin-guided therapy in seven of the eight studies. The absolute reduction in prescription rates ranged from -1.8 to -72 percent, and the reductions were statistically significant in all seven studies. Only one study reported an absolute increase in prescription rate by 6.0 percent, which was not statistically significant. A meta-analysis of eight studies yielded a statistically significant pooled risk difference of -22 percent (95% CI: -41% to -4%).
There was moderate-strength evidence that procalcitonin guidance reduced total antibiotic exposure. Four studies reported on total antibiotic exposure, which accounted for the use of multiple agents, as well as duration of therapy. Two studies reported the total exposure per 1,000 patient-days with relative reductions of 0.52 and 0.49, which were both highly statistically significant. One study reported an absolute reduction of -31.5 percent, which was highly statistically significant. One study reported a statistically significant relative risk of 0.55, but no additional details were given.
- Soni NJ, Samson DJ, Galaydick JL, et al. Procalcitonin-Guided Antibiotic Therapy. Comparative Effectiveness Review No. 78 (Prepared by the Blue Cross and Blue Shield Association Technology Evaluation Center Evidence-based Practice Center under Contract No. HHSA 290-2007-10058-I). Rockville, MD: Agency for Healthcare Research and Quality; August 2012. AHRQ Publication No. 12-EHC124-EF. Available at www.effectivehealthcare.ahrq.gov/procalcitonin.cfm.
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