Procalcitonin Guidance Halves Antibiotic Prescriptions in Upper Respiratory Tract Infections
An individual patient data meta-analysis of 644 primary care patients with upper respiratory tract infections showed that procalcitonin-guided therapy reduced antibiotic prescriptions from 51% to 18% (OR 0.2) and shortened antibiotic exposure by 2.4 days compared to usual care. There was no difference in treatment failure or days with restricted activity. These results extend the evidence for procalcitonin-guided stewardship beyond lower respiratory infections to common primary care presentations where antibiotic overuse is most prevalent.
The original study
Effects of procalcitonin testing on antibiotic use and clinical outcomes in patients with upper respiratory tract infections. An individual patient data meta-analysis.
- Authors
- Odermatt J, Friedli N, Kutz A, Briel M, Bucher HC, Christ-Crain M, et al.
- Journal
- Clinical chemistry and laboratory medicine
- Type
- Journal Article, Meta-Analysis
- PMID
- 28665787
Original abstract
BACKGROUND: Several trials found procalcitonin (PCT) helpful for guiding antibiotic treatment in patients with lower respiratory tract infections and sepsis. We aimed to perform an individual patient data meta-analysis on the effects of PCT guided antibiotic therapy in upper respiratory tract infections (URTI). METHODS: A comprehensive search of the literature was conducted using PubMed (MEDLINE) and Cochrane Library to identify relevant studies published until September 2016. We reanalysed individual data of adult URTI patients with a clinical diagnosis of URTI. Data of two trials were used based on PRISMA-IPD guidelines. Safety outcomes were (1) treatment failure defined as death, hospitalization, ARI-specific complications, recurrent or worsening infection at 28 days follow-up; and (2) restricted activity within a 14-day follow-up. Secondary endpoints were initiation of antibiotic therapy, and total days of antibiotic exposure. RESULTS: In total, 644 patients with a follow up of 28 days had a final diagnosis of URTI and were thus included in this analysis. There was no difference in treatment failure (33.1% vs. 34.0%, OR 1.0, 95% CI 0.7-1.4; p=0.896) and days with restricted activity between groups (8.0 vs. 8.0 days, regression coefficient 0.2 (95% CI -0.4 to 0.9), p=0.465). However, PCT guided antibiotic therapy resulted in lower antibiotic prescription (17.8% vs. 51.0%, OR 0.2, 95% CI 0.1-0.3; p<0.001) and in a 2.4 day (95% CI -2.9 to -1.9; p<0.001) shorter antibiotic exposure compared to control patients. CONCLUSIONS: PCT guided antibiotic therapy in the primary care setting was associated with reduced antibiotic exposure in URTI patients without compromising outcomes.