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Procalcitonin to guide initiation and duration of antibiotic treatment in acute respiratory infections: an individual patient data meta-analysis.

Type of publication Peer-reviewed
Publikationsform Original article (peer-reviewed)
Author Schuetz Philipp, Briel Matthias, Christ-Crain Mirjam, Stolz Daiana, Bouadma Lila, Wolff Michel, Luyt Charles-Edouard, Chastre Jean, Tubach Florence, Kristoffersen Kristina B, Wei Long, Burkhardt Olaf, Welte Tobias, Schroeder Stefan, Nobre Vandack, Tamm Michael, Bhatnagar Neera, Bucher Heiner C, Mueller Beat,
Project Preventing viral exacerbation of chronic obstructive pulmonary disease in upper respiratory tract infection - The PREVENT study
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Original article (peer-reviewed)

Journal Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
Volume (Issue) 55(5)
Page(s) 651 - 62
Title of proceedings Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
DOI 10.1093/cid/cis464

Abstract

BACKGROUND Procalcitonin algorithms may reduce antibiotic use for acute respiratory tract infections (ARIs). We undertook an individual patient data meta-analysis to assess safety of this approach in different ARI diagnoses and different clinical settings. METHODS We identified clinical trials in which patients with ARI were assigned to receive antibiotics based on a procalcitonin algorithm or usual care by searching the Cochrane Register, MEDLINE, and EMBASE. Individual patient data from 4221 adults with ARIs in 14 trials were verified and reanalyzed to assess risk of mortality and treatment failure-overall and within different clinical settings and types of ARIs. RESULTS Overall, there were 118 deaths in 2085 patients (5.7%) assigned to procalcitonin groups compared with 134 deaths in 2126 control patients (6.3%; adjusted odds ratio, 0.94; 95% confidence interval CI, .71-1.23)]. Treatment failure occurred in 398 procalcitonin group patients (19.1%) and in 466 control patients (21.9%; adjusted odds ratio, 0.82; 95% CI, .71-.97). Procalcitonin guidance was not associated with increased mortality or treatment failure in any clinical setting or ARI diagnosis. Total antibiotic exposure per patient was significantly reduced overall (median [interquartile range], from 8 [5-12] to 4 [0-8] days; adjusted difference in days, -3.47 [95% CI, -3.78 to -3.17]) and across all clinical settings and ARI diagnoses. CONCLUSIONS Use of procalcitonin to guide initiation and duration of antibiotic treatment in patients with ARIs was effective in reducing antibiotic exposure across settings without an increase in the risk of mortality or treatment failure. Further high-quality trials are needed in critical-care patients.
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