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Procalcitonin-Guided Antibiotic Therapy

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Background: The Need for Biomarkers To Guide Antibiotic Therapy for Bacterial Infections

The early initiation and appropriate use of antibiotics are important factors in managing several patient populations including:

Critically ill patients with suspected bacterial infections such as sepsis — Sepsis is a condition with high morbidity and mortality for which clinical diagnostic criteria lack sensitivity and specificity. Rapid diagnosis of sepsis and early initiation of antibiotic and goal-directed therapies have demonstrated a reduction in mortality. Other infections in critically ill patients that require early initiation of antibiotics include ventilator-associated pneumonia, neutropenic fever, and bacteremia.

Patients with upper and lower respiratory tract infections — Approximately 75 percent of all antibiotics prescribed in the ambulatory care setting are for acute upper and lower respiratory tract infections (RTIs). However, most acute RTIs are viral and do not benefit from antibiotic treatment. Upper bacterial RTIs (i.e., sinusitis, pharyngitis, and tonsillitis) and lower bacterial RTIs (i.e., pneumonia and bronchitis) may require antibiotic therapy. Clinical and microbiological evaluations lack the sensitivity and specificity to differentiate bacterial from viral RTIs.

Pediatric patients with suspected infections — These patients include those with localized infections such as pneumonia, urinary tract infection, and meningitis and those with systemic infections such as neutropenic fever, bacteremia, sepsis, and septic shock. Neonates with suspected sepsis are a particularly important group.

Patients in the postoperative setting with suspected infections — Patients with surgical site infections fall into this category.

A key clinical challenge associated with antibiotic therapy is that the overuse and misuse of antibiotics—including continuing antibiotics longer than necessary—can result in adverse effects and add to the increasing problem of antibiotic resistance.

However, the duration of antibiotic therapy that is appropriate for these patient populations is often undefined, and clinical features are of limited help in guiding discontinuation of therapy.