Procalcitonin guidance may lead to decreased antibiotic usageUsing procalcitonin, a biomarker of bacterial infection, as part of antibiotic therapy management has been shown to lead to reductions in antibiotic usage, according to a new Effective Health Care Program review by the Agency for Healthcare Research and Quality (AHRQ). The review, Procalcitonin-Guided Antibiotic Therapy (PDF File, Plugin Software Help), found that using procalcitonin to inform discontinuation of antibiotic therapy was associated with reductions in antibiotic usage. Procalcitonin-guided antibiotic discontinuation did not increase morbidity in critically ill patients. In contrast, procalcitonin-guided intensification of antibiotic therapy to broaden the spectrum of bacterial coverage was found to worsen outcomes in critically ill patients.
The review also found that in particular, among patients with respiratory tract infections (a type of infection that contributes substantially to the problem of antibiotic misuse), there was strong evidence to show that procalcitonin-guided treatment reduced antibiotic prescription rates and duration of antibiotic therapy in various clinical settings, without increasing morbidity or mortality. The findings of this review are of particular interest because a biomarker, such as procalcitonin, that has the potential to inform decisions about initiating, discontinuing, or changing antibiotic therapy, could have substantial clinical benefits for the treatment of bacterial infections.
The review notes that future studies will help determine if findings from this review will translate to high-risk groups, such as pregnant, immunocompromised, neonatal, and pediatric patients. Future research should also compare procalcitonin guidance to other methods for reducing unnecessary antibiotic use, including antibiotic stewardship programs and implementation of guidelines.
To access this review and other AHRQ materials that explore the effectiveness and options for treatment of various conditions, visit http://www.effectivehealthcare.ahrq.gov.