title: Procalcitonin-guided antibiotic therapy: a systematic review and meta-analysis.
abstract: BACKGROUND
  The utility of procalcitonin to manage patients with infections is unclear. A systematic review of comparative studies using procalcitonin-guided antibiotic therapy in patients with infections was performed.
  
  
  METHODS
  Randomized, controlled trials comparing procalcitonin-guided initiation, intensification, or discontinuation of antibiotic therapy to clinically guided therapy were included. Outcomes were antibiotic usage, morbidity, and mortality. MEDLINE, EMBASE, the Cochrane Database, National Institute for Clinical Excellence, the National Guideline Clearinghouse, and the Health Technology Assessment Programme were searched from January 1, 1990 to December 16, 2011.
  
  
  RESULTS
  Eighteen randomized, controlled trials were included. Data were pooled into clinically similar patient populations. In adult intensive care unit (ICU) patients, procalcitonin-guided discontinuation of antibiotics reduced antibiotic duration by 2.05 days (95% confidence interval [CI]: -2.59 to -1.52) without increasing morbidity or mortality. In contrast, procalcitonin-guided intensification of antibiotics in adult ICU patients increased antibiotic usage and morbidity. In adult patients with respiratory tract infections, procalcitonin guidance significantly reduced antibiotic duration by 2.35 days (95% CI: -4.38 to -0.33), antibiotic prescription rate by 22% (95% CI: -41% to -4%), and total antibiotic exposure without affecting morbidity or mortality. A single, good quality study of neonates with suspected sepsis demonstrated reduced antibiotic duration by 22.4 hours (P = 0.012) and reduced the proportion of neonates on antibiotics for ≥ 72 hours by 27% (P = 0.002) with procalcitonin guidance.
  
  
  CONCLUSIONS
  Procalcitonin guidance can safely reduce antibiotic usage when used to discontinue antibiotic therapy in adult ICU patients and when used to initiate or discontinue antibiotics in adult patients with respiratory tract infections.
authors: Division of Hospital Medicine, Department of Medicine, University of Texas Health Science Center San Antonio, San Antonio, Texas.
authors: Nilam J
authors: NJ
authors: Soni
authors: David J
authors: DJ
authors: Samson
authors: Jodi L
authors: JL
authors: Galaydick
authors: Vikrant
authors: V
authors: Vats
authors: Elbert S
authors: ES
authors: Huang
authors: Naomi
authors: N
authors: Aronson
authors: David L
authors: DL
authors: Pitrak
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002116:Calcitonin / Q000627:therapeutic use*; D015740:Calcitonin Gene-Related Peptide; D006023:Glycoproteins / Q000627:therapeutic use; D006801:Humans; D011498:Protein Precursors / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D012141:Respiratory Tract Infections / Q000188:drug therapy / Q000453:epidemiology; D018805:Sepsis / Q000188:drug therapy / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; C000606589:CALCA protein, human; D006023:Glycoproteins; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide