Procalcitonin guidance to reduce antibiotic treatment of lower respiratory tract infection in children and adolescents (ProPAED): a randomized controlled trial.
BACKGROUND
Antibiotics are overused in children and adolescents with lower respiratory tract infection (LRTI). Serum-procalcitonin (PCT) can be used to guide treatment when bacterial infection is suspected. Its role in pediatric LRTI is unclear.


METHODS
Between 01/2009 and 02/2010 we randomized previously healthy patients 1 month to 18 years old presenting with LRTI to the emergency departments of two pediatric hospitals in Switzerland to receive antibiotics either according to a PCT guidance algorithm established for adult LRTI or standard care clinical guidelines. In intention-to-treat analyses, antibiotic prescribing rate, duration of antibiotic treatment, and number of days with impairment of daily activities within 14 days of randomization were compared between the two groups.


RESULTS
In total 337 children, mean age 3.8 years (range 0.1-18), were included. Antibiotic prescribing rates were not significantly different in PCT guided patients compared to controls (OR 1.26; 95% CI 0.81, 1.95). Mean duration of antibiotic exposure was reduced from 6.3 to 4.5 days under PCT guidance (-1.8 days; 95% CI -3.1, -0.5; P = 0.039) for all LRTI and from 9.1 to 5.7 days for pneumonia (-3.4 days 95% CI -4.9, -1.7; P<0.001). There was no apparent difference in impairment of daily activities between PCT guided and control patients.


CONCLUSIONS
PCT guidance reduced antibiotic exposure by reducing the duration of antibiotic treatment, while not affecting the antibiotic prescribing rate. The latter may be explained by the low baseline prescribing rate in Switzerland for pediatric LRTI and the choice of an inappropriately low PCT cut-off level for this population.


BACKGROUND
Controlled-Trials.com ISRCTN17057980 http://www.controlled-trials.com/ISRCTN17057980.
Department of Pediatrics, University Basel, Basel, Switzerland.
Gurli
G
Baer
Philipp
P
Baumann
Michael
M
Buettcher
Ulrich
U
Heininger
Gerald
G
Berthet
Juliane
J
Schäfer
Heiner C
HC
Bucher
Daniel
D
Trachsel
Jacques
J
Schneider
Muriel
M
Gambon
Diana
D
Reppucci
Jessica M
JM
Bonhoeffer
Jody
J
Stähelin-Massik
Philipp
P
Schuetz
Beat
B
Mueller
Gabor
G
Szinnai
Urs B
UB
Schaad
Jan
J
Bonhoeffer
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D002648:Child; D006801:Humans; D011498:Protein Precursors / Q000097:blood*; D012141:Respiratory Tract Infections / Q000097:blood* / Q000188:drug therapy*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide