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Procalcitonin-guided antibiotic use vs a standard approach for acute respiratory tract infections in primary care Briel M; Schuetz P; Mueller B; Young J; Schild U; Nusbaumer C; Periat P; Bucher HC; Christ-Crain MArch Intern Med 2008[Oct]; 168 (18): 2000-7; discussion 2007-8BACKGROUND: Acute respiratory tract infections are the most common reason for antibiotic therapy in primary care despite their mainly viral etiology. A laboratory test measuring procalcitonin levels in blood specimens was suggested as a tool to reduce unnecessary prescribing of antibiotics. We consider whether antibiotic therapy guided by procalcitonin reduces the use of antibiotics without increasing the restrictions experienced by patients by more than 1 day. METHODS: Fifty-three primary care physicians recruited 458 patients, each patient with an acute respiratory tract infection and, in the physician's opinion, in need of antibiotics. Patients were centrally randomized to either a procalcitonin-guided approach to antibiotic therapy or to a standard approach. For patients randomized to procalcitonin-guided therapy, the use of antibiotics was more or less strongly discouraged (procalcitonin level, < or =0.1 or < or =0.25 microg/L, respectively) or recommended (procalcitonin level, >0.25 microg/L). Follow-up data were collected at 7 days by treating physicians and at 14 and 28 days by blinded interviewers. RESULTS: Adjusted for baseline characteristics, the mean increase at 14 days in days in which activities were restricted was 0.14 with procalcitonin-guided therapy (95% confidence interval [CI], -0.53 to 0.81 days), which met our criterion of an increase in days in which activities were restricted by no more than 1 day. With procalcitonin-guided therapy, the antibiotic prescription rate was 72% lower (95% CI, 66%-78%) than with standard therapy. Both approaches led to a similar proportion of patients reporting symptoms of ongoing or relapsing infection at 28 days (adjusted odds ratio, 1.0 [95% CI, 0.7-1.5]). CONCLUSIONS: As an adjunct to guidelines, procalcitonin-guided therapy markedly reduces antibiotic use for acute respiratory tract infections in primary care without compromising patient outcome. In practice, this could be achieved with 1 to 2 procalcitonin measurements in patients for whom the physician intends to prescribe antibiotics.|Acute Disease[MESH]|Adult[MESH]|Anti-Bacterial Agents/administration & dosage/*therapeutic use[MESH]|Biomarkers/blood[MESH]|Calcitonin Gene-Related Peptide[MESH]|Calcitonin/*blood[MESH]|Dose-Response Relationship, Drug[MESH]|Female[MESH]|Follow-Up Studies[MESH]|Glycoproteins[MESH]|Humans[MESH]|Male[MESH]|Middle Aged[MESH]|Primary Health Care/*methods[MESH]|Protein Precursors/*blood[MESH]|Respiratory Tract Infections/blood/*drug therapy[MESH]|Retrospective Studies[MESH]|Treatment Outcome[MESH] |
