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Procalcitonin-Guided Antibiotic Therapy

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Applicability of the Findings of This Review

This systematic review found that procalcitonin guidance for antibiotic discontinuation reduces antibiotic usage for adult patients in both medical and surgical intensive care units (ICUs); thus, the evidence from this review is applicable to clinical practice related to antibiotic discontinuation in the ICU setting.

Approximately 75 percent of all antibiotics prescribed in the ambulatory care setting are for acute respiratory tract infections (RTIs), most of which are viral and do not benefit from antibiotic treatment. Clinical and microbiological evaluations lack the sensitivity and specificity to differentiate bacterial from viral RTIs. This systematic review found that procalcitonin guidance for initiating and discontinuing antibiotic therapy for patients with RTIs in the ambulatory care or hospital setting significantly reduced antibiotic prescription rates and duration of use and, hence, is applicable to patients with respiratory tract infections in the hospital or ambulatory care setting.

Certain populations of interest were excluded from one or more of the studies of procalcitonin guidance reviewed in this report. Thus, findings from this review should not be extrapolated to these high-risk groups including pregnant women, immunocompromised patients, and patients with chronic infections such as endocarditis.