Respiratory Infection Outcomes Improved With Biomarker-Guided Therapy

Procalcitonin-guided therapy was associated with improved survival and reduced use of antibiotics and side-effects among patients with acute respiratory infections, according to the findings of a recent study.

For their meta-analysis, the researchers conducted a systematic literature review of trials that included patients with respiratory infections that were randomly assigned to receive antibiotics based on procalcitonin concentrations or control. The primary endpoints included 30-day mortality and setting-specific treatment failure. Antibiotic use, length of study, and antibiotic side-effects were assessed as secondary endpoints.
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A total of 26 trials with data on 6709 patients (3336 who received procalcitonin-guided therapy and 3372 in the control group) from 12 countries were included in the final analysis.

 At 30 days, mortality was significantly lower among patients who received procalcitonin-guided therapy compared with the control group (286 [9%] vs 336 [10%], respectively). This benefit was similar across subgroups by setting and type of infection, however mortality was lowest in primary care and in patients with acute bronchitis.

In addition, the use of procalcitonin-guided therapy was associated with a 2.4-day reduction in antibiotic exposure (5.7 days vs 8.1 days) and reduction in antibiotic related side-effects (15% vs 22%) compared with control.

“Use of procalcitonin to guide antibiotic treatment in patients with acute respiratory infections reduces antibiotic exposure and side-effects, and improves survival,” the researchers concluded. “Widespread implementation of procalcitonin protocols in patients with acute respiratory infections thus has the potential to improve antibiotic management with positive effects on clinical outcomes and on the current threat of increasing antibiotic multiresistance.”

—Melissa Weiss

Reference:

Schuetz P, Wirz Y, Sager R, et al. Effect of procalcitonin-guided antibiotic treatment on mortality in acute respiratory infections: a patient level meta-analysis [published online October 13, 2017]. Lancet Infect Diseas. http://dx.doi.org/10.1016/S1473-3099(17)30592-3.