Cochrane for Clinicians

Putting Evidence into Practice

Procalcitonin to Guide Antibiotic Therapy in Acute Respiratory Infections

 

Am Fam Physician. 2018 Jul 1;98(1):20-21.

Author disclosure: No relevant financial affiliations.

Clinical Question

Can using procalcitonin levels help guide antibiotic stewardship for patients with acute respiratory infections?

Evidence-Based Answer

Procalcitonin-guided antibiotic therapy, when compared with routine treatments, results in decreased mortality in patients with acute respiratory infections (absolute risk reduction [ARR] = 1.4%; number needed to treat [NNT] = 71). (Strength of Recommendation: A, based on consistent, good-quality patient-oriented evidence.) Compared with routine treatments, procalcitonin-guided antibiotic therapy also results in 2.4 fewer overall days of exposure to antibiotics and fewer overall antibiotic-related adverse effects (16% vs. 22% in the control group).1 (Strength of Recommendation: B, based on inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

Acute respiratory infections are the most common reason for antibiotic therapy in primary care and hospital settings.24 Appropriate treatment, including judicious use of antibiotics, is associated with improved clinical outcomes.35 Procalcitonin is a calcitonin precursor whose serum levels rise in the setting of bacterial infection; procalcitonin-guided antibiotic therapy is already used in many clinical settings. This Cochrane analysis was designed to evaluate whether procalcitonin-guided antibiotic therapy for acute respiratory infections leads to improved outcomes vs. routine management. It is an update of a 2012 review.

The authors included 26 randomized controlled trials with a total of 6,708 patients who had acute respiratory infections.1 Outcomes included all-cause mortality, treatment failure, and duration of antibiotic exposure. Per GRADE (grading of recommendations, assessment, development, and evaluation) criteria, the data in this review were deemed to be of high quality for mortality and antibiotic exposure outcomes. Data were deemed to be of moderate quality for treatment failure and adverse effects because the definitions for these end points

Author disclosure: No relevant financial affiliations.


The practice recommendations in this activity are available at http://www.cochrane.org/CD007498.

The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of Defense, the U.S. Army, U.S. Air Force, U.S. Navy, or the Uniformed Services University of the Health Sciences.

References

show all references

1. Schuetz P, Wirz Y, Sager R, et al. Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections. Cochrane Database Syst Rev. 2017;(10):CD007498....

2. Evans AT, Husain S, Durairaj L, Sadowski LS, Charles-Damte M, Wang Y. Azithromycin for acute bronchitis: a randomised, double-blind, controlled trial. Lancet. 2002;359(9318):1648–1654.

3. Gonzales R, Steiner JF, Sande MA. Antibiotic prescribing for adults with colds, upper respiratory tract infections, and bronchitis by ambulatory care physicians. JAMA. 1997;278(11):901–904.

4. Zaas AK, Garner BH, Tsalik EL, Burke T, Woods CW, Ginsburg GS. The current epidemiology and clinical decisions surrounding acute respiratory infections. Trends Mol Med. 2014;20(10):579–588.

5. Doan Q, Enarson P, Kissoon N, Klassen TP, Johnson DW. Rapid viral diagnosis for acute febrile respiratory illness in children in the emergency department. Cochrane Database Syst Rev. 2014;(9):CD006452.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, Assistant Medical Editor.

A collection of Cochrane for Clinicians published in AFP is available at https://www.aafp.org/afp/cochrane.

 

 

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