title: How to reduce antibiotic consumption for community-acquired pneumonia?
abstract: BACKGROUND
  The difficulty to diagnose community-acquired pneumonia (CAP) and the lack of scientific data regarding the optimal duration of antibiotic therapy are responsible for overprescribing antibiotics.
  
  
  OBJECTIVE
  The authors had for objective to perform a systematic review of the international medical literature on strategies aimed at reducing antibiotic consumption for CAP.
  
  
  METHODS
  We performed a Pubmed search using the keywords CAP, antibiotic use, duration of antibiotic therapy, procalcitonin, short-course treatment, and biomarkers. We then made a critical review of the selected articles.
  
  
  RESULTS
  Our review identified two strategies used to reduce antibiotic consumption for CAP. The first one was based on procalcitonin (PCT) use. This strategy, even though reducing the duration of antibiotic therapy, does not seem optimal since it is associated with longer antibiotic treatment than recommended by the Infectious Diseases Society of America. Moreover, this strategy is associated with an increased cost in biochemical tests. The other strategy is based on a 2-step clinical reassessment: 1) during the first 24 hours of hospitalization, to confirm the diagnosis of CAP and 2) during hospitalization, to shorten the duration of antibiotic therapy according to the patient's clinical status.
  
  
  CONCLUSIONS
  Clinical reassessment, currently little studied compared to PCT guidance algorithm, seems to be promising to reduce antibiotic consumption for CAP. Especially since it was never compared to PCT guidance strategy in a randomized clinical trial.
authors: Service des urgences, hôpital Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France. emmanuel.montassier@chu-nantes.fr
authors: E
authors: E
authors: Montassier
authors: N
authors: N
authors: Goffinet
authors: G
authors: G
authors: Potel
authors: E
authors: E
authors: Batard
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D015415:Biomarkers; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D002986:Clinical Trials as Topic; D017714:Community-Acquired Infections / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D003937:Diagnosis, Differential; D004334:Drug Administration Schedule; D004363:Drug Utilization; D006760:Hospitalization; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control*; D011014:Pneumonia / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D011498:Protein Precursors / Q000097:blood; D011654:Pulmonary Edema / Q000175:diagnosis
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide