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Procalcitonin measurements for guiding antibiotic treatment in pediatric pneumonia
Respiratory Medicine, 11/18/2011
Clinical Article
Esposito S et al. – The results of this first prospective study using a procalcitonin(PCT) cut-off value to guide antibiotic therapy for pediatric community-acquired pneumonia(CAP) showed that this approach can significantly reduce antibiotic use and antibiotic-related adverse events in children with uncomplicated disease. However, because the study included mainly children with mild to moderate CAP and the risk of the use of the algorithm-based approach was not validated in a relevant number of severe cases, further studies are needed before it can be used in routine clinical practice.
- In order to evaluate the use of an algorithm based on a procalcitonin (PCT) cut-off value as a means of guiding antibiotic therapy, 319 hospitalised children with uncomplicated community-acquired pneumonia (CAP) were randomised 1:1 to be treated on the basis of the algorithm or in accordance with standard guidelines.
- The children in the PCT group did not receive antibiotics if their PCT level upon admission was <0.25ng/mL, and those receiving antibiotics from the time of admission were treated until their PCT level was ≥0.25ng/mL.
- The final analysis was based on 155 patients in the PCT group and 155 in the control group.
- In comparison with the controls, the PCT group received significantly fewer antibiotic prescriptions (85.8% vs 100%; p<0.05), were exposed to antibiotics for a shorter time (5.37 vs 10.96 days; p<0.05), and experienced fewer antibiotic-related adverse events (3.9% vs 25.2%; p<0.05), regardless of CAP severity.
- There was no significant between-group difference in recurrence of respiratory symptoms and new antibiotic prescription in the month following enrollment.
