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Procalcitonin-guidance for reduction of antibiotic use in low-risk outpatients with community acquired pneumonia.
MedLine Citation:
PMID:  21507143     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
SUMMARY AT A GLANCE: Antibiotic use in outpatients with community acquired pneumonia is determined empirically, which may lead to overuse and selection pressure for resistance. Procalcitonin guidance allows a reduction in antibiotic use and shortening of the duration of antibiotic therapy in low-risk outpatients with community acquired pneumonia, without apparent harm. ABSTRACT: Background and objective:  Use of antibiotics in outpatients with community acquired pneumonia (CAP) is empirical, which may lead to overuse and selection pressure for resistance. Procalcitonin (PCT) levels may predict the severity of CAP and may be used to guide antibiotic use in hospitalized patients. This study evaluated the value of PCT measurements for guiding antibiotic use in low-risk outpatients with CAP. Methods:  This was a randomized intervention trial conducted between February 2005 and December 2008 that included 172 consecutive patients with suspected CAP, of whom 156 completed the study. The control group received antibiotics according to current guidelines. In the PCT group, antibiotic treatment was based on PCT levels as follows: <0.1 µg/L, strongly discouraged; <0.25 µg/L, discouraged; >0.25 µg/L, encouraged. The primary endpoints were total antibiotic use and duration of antibiotic treatment; laboratory and clinical outcomes were measured. Results:  Prescription of antibiotics on admission (84.4 vs. 97.5%; P= 0.004), total antibiotic exposure (relative risk 0.55, 95% CI 0.51-0.60; P= 0.003), and duration of antibiotic treatment (median 5 days vs. 7 days; P < 0.001) were reduced in the PCT guidance group, compared with patients treated according to current guidelines. At four-week follow up, all patients had survived and laboratory and clinical outcomes were similar in the two groups. Conclusions:  Under PCT guidance, antibiotic use was reduced and duration of antibiotic treatment was shortened in low-risk outpatients with CAP, without apparent harm.
Authors:
Wei Long; Xingqi Deng; Yu Zhang; Gang Lu; Juan Xie; Jianguo Tang
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-4-20
Journal Detail:
Title:  Respirology (Carlton, Vic.)     Volume:  -     ISSN:  1440-1843     ISO Abbreviation:  -     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-4-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9616368     Medline TA:  Respirology     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2011 The Authors. Respirology © 2011 Asian Pacific Society of Respirology.
Affiliation:
Department of Emergency Medicine, and Department of Pulmonary Medicine, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China.
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