Procalcitonin-Guided Antibiotic Therapy
Effects of Using Procalcitonin To Guide Antibiotic Therapy in Patients With RTIs in the Ambulatory Care or Hospital Setting (2 of 2)
There was moderate-strength evidence that procalcitonin guidance did not increase mortality, hospital length of stay, or intensive care unit (ICU) admission rates.
- Overall mortality results were consistent and did not suggest higher mortality rates with procalcitonin-guided therapy when compared with the control arm. Mortality rates in patients in the control arm ranged from 0 to 13.2 percent. The absolute differences between the procalcitonin and control arms ranged from -3.6 to 1.0 percent. Six studies reported 28-day mortality; none of the differences in 28-day mortality were statistically significant.
- Five studies reported hospital length of stay. Hospital length of stay was reduced with procalcitonin-guided therapy in four of five studies, with an absolute reduction in days ranging from -0.5 to -1. The differences were not statistically significant in any of the studies.
- Five studies reported the need for ICU admission. ICU admission rates were reduced with procalcitonin-guided therapy with absolute reductions ranging from -0.7 to -2.5 percent. None of the reductions in ICU admissions was statistically significant.
Three studies reported on antibiotic adverse effects; however, the data were inconsistent and imprecise. Two studies reported percentages with absolute differences of -8.2 percent and 2.8 percent, and one study reported an absolute difference of -1.1 days that was statistically significant. The data for this outcome were limited and did not permit conclusions about the impact of procalcitonin-guided therapy on antibiotic-associated adverse events; the strength of evidence for this finding was rated insufficient.
- 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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