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Procalcitonin guidance of antibiotic therapy in community-acquired pneumonia: a randomized trial

Christ-Crain, M. and Stolz, D. and Bingisser, R. and Muller, C. and Miedinger, D. and Huber, P. R. and Zimmerli, W. and Harbarth, S. and Tamm, M. and Muller, B.. (2006) Procalcitonin guidance of antibiotic therapy in community-acquired pneumonia: a randomized trial. American Journal of Respiratory and Critical Care Medicine, 174 (1). pp. 84-93.

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Official URL: http://edoc.unibas.ch/56755/

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Abstract

RATIONALE: In patients with community-acquired pneumonia, guidelines recommend antibiotic treatment for 7 to 21 d. Procalcitonin is elevated in bacterial infections, and its dynamics have prognostic implications. OBJECTIVE: To assess procalcitonin guidance for the initiation and duration of antibiotic therapy in community-acquired pneumonia. METHODS: In a randomized intervention trial, 302 consecutive patients with suspected community-acquired pneumonia were included. Data were assessed at baseline, after 4, 6, and 8 d, and after 6 wk. The control group (n = 151) received antibiotics according to usual practice. In the procalcitonin group (n = 151), antibiotic treatment was based on serum procalcitonin concentrations as follows: strongly discouraged, less than 0.1 microg/L; discouraged, less than 0.25 microg/L; encouraged, greater than 0.25 microg/L; strongly encouraged, greater than 0.5 microg/L. The primary endpoint was antibiotic use; secondary endpoints were measures of clinical, laboratory, and radiographic outcome. RESULTS: At baseline, both groups were similar regarding clinical, laboratory, and microbiology characteristics, and Pneumonia Severity Index. Procalcitonin guidance reduced total antibiotic exposure (relative risk, 0.52; 95% confidence interval, 0.48-0.55; p > 0.001), antibiotic prescriptions on admission (85 vs. 99%; p > 0.001), and antibiotic treatment duration (median, 5 vs. 12 d; p > 0.001) compared with patients treated according to guidelines. After adjustment for Pneumonia Severity Index, the hazard ratio of antibiotic discontinuation was higher in the procalcitonin group than in the control group (3.2; 95% confidence interval, 2.5 to 4.2). Outcome was similar in both groups, with an overall success rate of 83%. CONCLUSIONS: Procalcitonin guidance substantially reduces antibiotic use in community-acquired pneumonia. These findings may have important clinical and public health implications.
Faculties and Departments:03 Faculty of Medicine > Bereich Medizinische Fächer (Klinik) > Allgemeine innere Medizin AG > Argovia Professur für Medizin (Müller)
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Medizinische Fächer (Klinik) > Allgemeine innere Medizin AG > Argovia Professur für Medizin (Müller)
UniBasel Contributors:Müller, Beat
Item Type:Article, refereed
Article Subtype:Research Article
Publisher:American Thoracic Society
ISSN:1073-449X
e-ISSN:1535-4970
Note:Publication type according to Uni Basel Research Database: Journal article
Identification Number:
Last Modified:27 Nov 2017 11:25
Deposited On:27 Nov 2017 11:25

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