Procalcitonin testing does not decrease antibiotic use for LRTIs


Clinical question: Does testing procalcitonin for lower respiratory tract infections (LRTIs) decrease total antibiotic days without a resultant increase in adverse events?

Background: LRTIs are frequently overtreated with antibiotics. Procalcitonin may indicate bacterial infection and promote antibacterial stewardship. Studies to evaluate how testing procalcitonin affects antibiotic use for suspected lower respiratory tract infections are limited.

Study design: Randomized 1:1 intention-to-treat, multicenter trial.

Setting: 14 U.S. urban academic hospitals.

Synopsis: 1,656 patients across 14 U.S. hospitals were randomized to initial procalcitonin results available prior to clinical decision making versus usual care. All providers were given Food and Drug Administration–approved guidelines to interpret procalcitonin results. In the procalcitonin group, procalcitonin levels were followed serially. Within 30 days of the initial encounter, total antibiotic days did not differ significantly between the two groups. Procalcitonin use did not significantly affect adverse outcomes including organ system failure, death, ICU admission, hospital readmission, or ED visits. A total of 20% of antibiotic prescriptions were written prior to the procalcitonin result. Providers who did not adhere to guidelines either cited a diagnosis of chronic obstructive pulmonary disease or discounted the value of procalcitonin and presumptively diagnosed bacterial infection (40% of cases).

Bottom line: Procalcitonin testing did not change provider practice patterns for antibiotic prescriptions for LRTIs.

Citation: Huang DT et al. Procalcitonin-guided use of antibiotics for lower respiratory tract infection. N Engl J Med. 2018 Jul 19;379(3):236-49.

Dr. Naderi is assistant professor in the division of hospital medicine, University of Colorado, Denver.

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