The DOI matches its Crossref record; 38 of the 38 references it cites were found in a registry or an index.
Procalcitonin Algorithms for Antibiotic Therapy Decisions: A Systematic Review of Randomized Controlled Trials and Recommendations for Clinical Algorithms
Abstract
Previous randomized controlled trials suggest that using clinical algorithms based on procalcitonin levels, a marker of bacterial infections, results in reduced antibiotic use without a deleterious effect on clinical outcomes. However, algorithms differed among trials and were embedded primarily within the European health care setting. Herein, we summarize the design, efficacy, and safety of previous randomized controlled trials and propose adapted algorithms for US settings. We performed a systematic search and included all 14 randomized controlled trials (N = 4467 patients) that investigated procalcitonin algorithms for antibiotic treatment decisions in adult patients with respiratory tract infections and sepsis from primary care, emergency department (ED), and intensive care unit settings. We found no significant difference in mortality between procalcitonin-treated and control patients overall (odds ratio, 0.91; 95% confidence interval, 0.73-1.14) or in primary care (0.13; 0-6.64), ED (0.95; 0.67-1.36), and intensive care unit (0.89; 0.66-1.20) settings individually. A consistent reduction was observed in antibiotic prescription and/or duration of therapy, mainly owing to lower prescribing rates in low-acuity primary care and ED patients, and shorter duration of therapy in moderate- and high-acuity ED and intensive care unit patients. Measurement of procalcitonin levels for antibiotic decisions in patients with respiratory tract infections and sepsis appears to reduce antibiotic exposure without worsening the mortality rate. We propose specific procalcitonin algorithms for low-, moderate-, and high-acuity patients as a basis for future trials aiming at reducing antibiotic overconsumption.
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Self-citationIncreasing Prevalence of Multidrug-Resistant Streptococcus pneumoniae in the United States
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Cited by
Procalcitonin as a diagnostic marker for sepsis: A systematic review and meta-analysis.
Wacker, C., Prkno, A., Brunkhorst, F. M., & Schlattmann, P. (2013) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(12)70323-7 · Cited by 1,198
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Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections
Schuetz, P., Wirz, Y., Sager, R., Christ-Crain, M., Stolz, D., Tamm, M., Bouadma, L., Luyt, C. E., Wolff, M., Chastre, J., et al. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd007498.pub3 · Cited by 649
Self-citationNew Approaches to Sepsis: Molecular Diagnostics and Biomarkers
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Metadata
- Authors
- Schuetz, P.
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2011-08-08
- Volume
- 171
- Issue
- 15
- Pages
- 1322
- ISSN
- 0003-9926 (ISSN-L)
- OpenAlex
- W2162217108
- Cited by
- 386
- References
- 38
- FWCI
- 28.53
- Type
- journal article
- Language
- en
- Open access
- closed
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