title: Procalcitonin guidance for reduction of antibiotic use in patients hospitalized with severe acute exacerbations of asthma: a randomized controlled study with 12-month follow-up.
abstract: BACKGROUND
  Patients with severe acute exacerbations of asthma often receive inappropriate antibiotic treatment. We aimed to determine whether serum procalcitonin (PCT) levels can effectively and safely reduce antibiotic exposure in patients experiencing exacerbations of asthma.
  
  
  METHODS
  In this randomized controlled trial, a total of 216 patients requiring hospitalization for severe acute exacerbations of asthma were screened for eligibility to participate and 169 completed the 12-month follow-up visit. Patients were randomized to either PCT-guided (PCT group) or standard (control group) antimicrobial therapy. In the control group, patients received antibiotics according to the attending physician's discretion; in the PCT group, patients received antibiotics according to an algorithm based on serum PCT levels. The primary end point was antibiotic exposure; secondary end points were clinical recovery, length of hospital stay, clinical and laboratory parameters, spirometry, number of asthma exacerbations, emergency room visits, hospitalizations and need for corticosteroid use due to asthma.
  
  
  RESULTS
  PCT guidance reduced antibiotic prescription (48.9% versus 87.8%, respectively; P < 0.001) and antibiotic exposure (relative risk, 0.56; 95% confidence interval, 0.44 to 0.70; P < 0.001) compared to standard therapy. There were no significant differences in clinical recovery, length of hospital stay or clinical, laboratory and spirometry outcomes in both groups. Number of asthma exacerbations, emergency room visits, hospitalizations and need for corticosteroid use due to asthma were similar during the 12-month follow-up period.
  
  
  CONCLUSIONS
  A PCT-guided strategy allows antibiotic exposure to be reduced in patients with severe acute exacerbation of asthma without apparent harm.
  
  
  BACKGROUND
  Chinese Clinical Trial Register ChiCTR-TRC-12002534 (registered 26 September 2012).
authors.forename: Wei
authors.initials: W
authors.lastname: Long
authors.forename: Li-Juan
authors.initials: LJ
authors.lastname: Li
authors.forename: Gao-Zhong
authors.initials: GZ
authors.lastname: Huang
authors.forename: Xue-Min
authors.initials: XM
authors.lastname: Zhang
authors.forename: Yi-Cui
authors.initials: YC
authors.lastname: Zhang
authors.forename: Jian-Guo
authors.initials: JG
authors.lastname: Tang
authors.forename: Yu
authors.initials: Y
authors.lastname: Zhang
authors.forename: Gang
authors.initials: G
authors.lastname: Lu
mesh_terms: D000208:Acute Disease / Q000628:therapy*; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001249:Asthma / Q000097:blood / Q000188:drug therapy*; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D004363:Drug Utilization / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011498:Protein Precursors / Q000097:blood*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide