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Streamlining antibiotic therapy with procalcitonin protocols: consensus and controversies
Journal
Expert Review of Respiratory Medicine
Volume
7
Number
2
Pages
145-57
Keywords
Algorithms; Anti-Bacterial Agents/*administration & dosage/adverse effects; Bacterial Infections/diagnosis/*drug therapy/*metabolism/microbiology; Biological Markers/metabolism; Calcitonin/*metabolism; Clinical Protocols; Drug Administration Schedule; Drug Resistance, Bacterial; Drug Utilization; Humans; Physician's Practice Patterns; Practice Guidelines as Topic; Predictive Value of Tests; Protein Precursors/*metabolism; Treatment Outcome; Unnecessary Procedures
Abstract
Accumulating evidence supports procalcitonin (PCT) as an accurate surrogate biomarker for likelihood and severity of bacterial infections. In community-acquired pneumonia and other respiratory infections, PCT-guided antibiotic therapy algorithms resulted in reduced antibiotic exposure while maintaining a similar or even better level of safety compared with standard care. Reductions in antibiotic use translate into lower treatment costs, decreased risk of side effects and decreased bacterial multiresistance. This is especially important, as acute respiratory infections represent the most frequent reason for antibiotic prescriptions worldwide. Still, there is some controversy about the benefits of PCT measurement in sepsis patients in the intensive care unit and for nonrespiratory infections. Highly sensitive PCT assays are readily available in many hospitals today, and point-of-care assays with high enough sensitivity for antibiotic guidance are expected to be available soon. Herein, the authors provide an overview of recent studies evaluating PCT in different clinical situations and an outlook of currently enrolling or upcoming interventional trials.
