title: Procalcitonin to guide initiation and duration of antibiotic treatment in acute respiratory infections: an individual patient data meta-analysis.
abstract: BACKGROUND
  Procalcitonin algorithms may reduce antibiotic use for acute respiratory tract infections (ARIs). We undertook an individual patient data meta-analysis to assess safety of this approach in different ARI diagnoses and different clinical settings.
  
  
  METHODS
  We identified clinical trials in which patients with ARI were assigned to receive antibiotics based on a procalcitonin algorithm or usual care by searching the Cochrane Register, MEDLINE, and EMBASE. Individual patient data from 4221 adults with ARIs in 14 trials were verified and reanalyzed to assess risk of mortality and treatment failure-overall and within different clinical settings and types of ARIs.
  
  
  RESULTS
  Overall, there were 118 deaths in 2085 patients (5.7%) assigned to procalcitonin groups compared with 134 deaths in 2126 control patients (6.3%; adjusted odds ratio, 0.94; 95% confidence interval CI, .71-1.23)]. Treatment failure occurred in 398 procalcitonin group patients (19.1%) and in 466 control patients (21.9%; adjusted odds ratio, 0.82; 95% CI, .71-.97). Procalcitonin guidance was not associated with increased mortality or treatment failure in any clinical setting or ARI diagnosis. Total antibiotic exposure per patient was significantly reduced overall (median [interquartile range], from 8 [5-12] to 4 [0-8] days; adjusted difference in days, -3.47 [95% CI, -3.78 to -3.17]) and across all clinical settings and ARI diagnoses.
  
  
  CONCLUSIONS
  Use of procalcitonin to guide initiation and duration of antibiotic treatment in patients with ARIs was effective in reducing antibiotic exposure across settings without an increase in the risk of mortality or treatment failure. Further high-quality trials are needed in critical-care patients.
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, and Harvard School of Public Health, Boston, MA 02115, USA. schuetzph@gmail.com
authors.forename: Philipp
authors.initials: P
authors.lastname: Schuetz
authors.forename: Matthias
authors.initials: M
authors.lastname: Briel
authors.forename: Mirjam
authors.initials: M
authors.lastname: Christ-Crain
authors.forename: Daiana
authors.initials: D
authors.lastname: Stolz
authors.forename: Lila
authors.initials: L
authors.lastname: Bouadma
authors.forename: Michel
authors.initials: M
authors.lastname: Wolff
authors.forename: Charles-Edouard
authors.initials: CE
authors.lastname: Luyt
authors.forename: Jean
authors.initials: J
authors.lastname: Chastre
authors.forename: Florence
authors.initials: F
authors.lastname: Tubach
authors.forename: Kristina B
authors.initials: KB
authors.lastname: Kristoffersen
authors.forename: Long
authors.initials: L
authors.lastname: Wei
authors.forename: Olaf
authors.initials: O
authors.lastname: Burkhardt
authors.forename: Tobias
authors.initials: T
authors.lastname: Welte
authors.forename: Stefan
authors.initials: S
authors.lastname: Schroeder
authors.forename: Vandack
authors.initials: V
authors.lastname: Nobre
authors.forename: Michael
authors.initials: M
authors.lastname: Tamm
authors.forename: Neera
authors.initials: N
authors.lastname: Bhatnagar
authors.forename: Heiner C
authors.initials: HC
authors.lastname: Bucher
authors.forename: Beat
authors.initials: B
authors.lastname: Mueller
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002116:Calcitonin / Q000008:administration & dosage*; D015740:Calcitonin Gene-Related Peptide; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011498:Protein Precursors / Q000008:administration & dosage*; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis; D012141:Respiratory Tract Infections / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide