title: Management of patients with respiratory infections in primary care: procalcitonin, C-reactive protein or both?
abstract: Use of inflammatory biomarkers to guide antibiotic decisions has shown promising results in the risk-adapted management of respiratory tract infections, mainly in the inpatient setting. Several observational and interventional trials have investigated the benefits of procalcitonin (PCT) and C-reactive protein (CRP) testing in primary care. Both markers have shown promising results, although CRP is an inflammatory biomarker while PCT is more specific for bacterial infections. For CRP, point-of-care testing is widely established. Recently, sensitive point-of-care testing for PCT has also become available. A high-quality trial comparing these two markers for the management of patients in primary care is currently lacking. The aim of this paper is to review the existing literature investigating the use of PCT and CRP in primary care. The authors compare their performance for guiding antibiotic stewardship and analyze the cut-off values and endpoints to put these parameters into context in a low-acuity environment.
authors.affiliation: a 1 Medical University Department, Kantonsspital Aarau - Endocrinology/Diabetes/Clinical Nutrition and Internal Medicine, Aarau, CH 5000, Switzerland.
authors.forename: Marc
authors.initials: M
authors.lastname: Meili
authors.affiliation: a 1 Medical University Department, Kantonsspital Aarau - Endocrinology/Diabetes/Clinical Nutrition and Internal Medicine, Aarau, CH 5000, Switzerland.
authors.forename: Beat
authors.initials: B
authors.lastname: Müller
authors.affiliation: b 2 Asclepius Medical Communications LLC, Ridgewood, NJ 0750, USA.
authors.forename: Prasad
authors.initials: P
authors.lastname: Kulkarni
authors.affiliation: a 1 Medical University Department, Kantonsspital Aarau - Endocrinology/Diabetes/Clinical Nutrition and Internal Medicine, Aarau, CH 5000, Switzerland.
authors.forename: Philipp
authors.initials: P
authors.lastname: Schütz
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000097:blood* / Q000188:drug therapy*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D006801:Humans; D011320:Primary Health Care; D011498:Protein Precursors / Q000097:blood*; D012141:Respiratory Tract Infections / Q000097:blood* / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide
keywords: C-reactive protein; ambulatory care; antibiotic guidance; biomarker; general practice; primary care; procalcitonin