Clinical Question

Does the use of procalcitonin and C-reactive protein levels to guide antibiotic use decrease antibiotic duration in hospitalized patients?

Bottom Line

The meta-analysis showed decreased duration of antibiotic use in hospitalized patients with sepsis or respiratory tract infections with the use of procalcitonin guidance. Less research is available on the use of C-reactive protein for the same purpose. (Level of Evidence = 1a−)

Synopsis

The authors searched multiple databases, including PubMed and EMBASE, to find randomized controlled trials that evaluated the use of procalcitonin and C-reactive protein levels in determining antibiotic duration in hospitalized adults. The authors outlined a search strategy, performed a risk of bias assessment for included studies, and extracted data using a predefined form. It was unclear whether these functions were performed independently by the individual authors. Overall, 27 studies were included in the systematic review (25 studies examined the use of procalcitonin; two evaluated the use of C-reactive protein), and 21 of these were included in the meta-analysis. The risk of bias was high in most of the studies due to lack of masking. The primary outcome was duration of antibiotic use in patients with sepsis or respiratory infections. Although procalcitonin guidance resulted in statistically significant decreased duration of antibiotics in sepsis and respiratory infections (standardized mean difference = −0.59; 95% CI, −0.85 to −0.33), there was high heterogeneity for this result. There were no significant differences in secondary outcomes of length of stay, 28-day mortality, or recurrence of infection. The use of procalcitonin was associated with reduced in-hospital mortality (odds ratio = 0.62; 95% CI, 0.41 to 0.94). One of the two C-reactive protein studies showed a statistically significant decrease in duration of antibiotics using C-reactive protein guidance in critically ill patients. There were no effects of C-reactive protein guidance on any secondary outcomes.