Ameta-analysis found that procalcitonin (PCT)-guided antibiotic therapy in patients with acute respiratory infections reduces use of and side-effects from antibiotics while also improving survival (Lancet Infect Dis 2017; doi.org/10.1016/S1473-3099(17)30592-3).
Prior studies and meta-analyses found PCT-guided treatment reduced antibiotic exposure, but some trials lacked statistical power to make conclusions about mortality and some meta-analyses had been based on aggregate rather than individual patient data, restricting the ability to harmonize outcome definitions and evaluate differences between subgroups.
The authors collected data on 6,708 patients from 26 eligible trials in 12 countries. These trials had randomly assigned patients to receive antibiotics based on PCT concentrations versus control groups.
The researchers found that 30-day mortality was significantly lower in patients who received PCT-guided care than in control patients with an adjusted odds ratio of 0.83, a mortality benefit that extended across subgroups by setting and type of infection. PCT-guided care also was associated with a 2.4-day reduction in antibiotic exposure and reduced antibiotic-related side effects, with an adjusted odds ratio of 0.68.