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Procalcitonin-Guided Antibiotic Therapy

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Effects of Using Procalcitonin To Guide Antibiotic Therapy in Pediatric Patients

Procalcitonin guidance reduced the use of antibiotic therapy in neonates with suspected sepsis. The strength of evidence for this finding was rated moderate. A single study of 101 neonates reported on procalcitonin-guided antibiotic usage. The duration of antibiotic use was significantly decreased overall by 22.4 hours (24% reduction; P = 0.002), with the greatest differences seen for the 80 to 85 percent of neonates who had possible infection or were unlikely to have infection and little difference for the small proportion of neonates with proven or probable infection. The proportion of neonates on antibiotics for 72 or more hours was significantly reduced overall by 27 percent (P = 0.012). There were no deaths in either arm. A small, statistically insignificant reduction in morbidity (assessed as infection recurrence rates) was observed.

The strength of evidence was judged insufficient to permit conclusions on outcomes of procalcitonin-guided antibiotic therapy for fever of unknown source in children 1–36 months of age. A single study was identified that reported on procalcitonin guidance for antibiotic therapy in children aged 1–36 months with fever. There were no differences in the antibiotic prescription rates or hospitalization rate, although rates were low for both arms with only one-quarter of children being hospitalized and receiving antibiotics.