title: Procalcitonin-guided therapy for the initiation of antibiotics in the ED: a systematic review.
abstract: BACKGROUND
  Procalcitonin (PCT) is a new biomarker with a higher accuracy in the diagnosis of bacterial infections. Utilization of PCT may reduce the number of unnecessary antibiotics prescribed to patients and consequently may decrease the rise in antibiotic resistance. The aim of this systematic review is to determine if a PCT-guided algorithm can safely reduce the number of antibiotics prescribed to all patients with a suspected of infection in the emergency department (ED).
  
  
  METHODS
  MEDLINE, EMBASE, Web of Science, COCHRANE central, PubMed publisher, and Google scholar were searched. Two reviewers performed the screening independently. The QUADAS 2 tool was used to assess quality.
  
  
  RESULTS
  In total, 1621 articles were screened. Nine articles were included in the analysis. In the 6 studies on adult patients, only patients with respiratory tract infections were investigated. In these studies, a cutoff value of 0.25 μg/L was used, and PCT-guided therapy reduced the number of prescribed antibiotics significantly. Three studies were on pediatric patients, 2 on fever without source and 1 on respiratory complaints. Procalcitonin-guided therapy did not reduce antibiotic prescription in children. Procalcitonin-guided therapy did not result in an increase in adverse events in any of the studies.
  
  
  CONCLUSIONS
  Procalcitonin-guided therapy in the ED is only studied in subpopulations, where it was effective and safe in adult patients with respiratory tract infections and not effective but safe nonetheless in specific pediatric populations. Nonadherence is a significant problem in prospective PCT-guided therapy studies. There is not enough evidence to use PCT-guided therapy in a general ED population.
authors.affiliation: Department of Emergency Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands. Electronic address: y.vanderdoes@erasmusmc.nl.
authors.forename: Yuri
authors.initials: Y
authors.lastname: van der Does
authors.affiliation: Department of Emergency Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands. Electronic address: p.rood@erasmusmc.nl.
authors.forename: Pleunie P M
authors.initials: PP
authors.lastname: Rood
authors.affiliation: Department of Emergency Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands. Electronic address: j.haagsma@erasmusmc.nl.
authors.forename: Juanita A
authors.initials: JA
authors.lastname: Haagsma
authors.affiliation: Department of Emergency Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands. Electronic address: p.patka@erasmusmc.nl.
authors.forename: Peter
authors.initials: P
authors.lastname: Patka
authors.affiliation: Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Viroscience, Erasmus University Medical Center, Rotterdam, The Netherlands. Electronic address: e.vangorp@erasmusmc.nl.
authors.forename: Eric C M
authors.initials: EC
authors.lastname: van Gorp
authors.affiliation: Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands. Electronic address: m.limper@erasmusmc.nl.
authors.forename: Maarten
authors.initials: M
authors.lastname: Limper
mesh_terms: D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000097:blood* / Q000175:diagnosis* / Q000188:drug therapy; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D000066491:Clinical Decision-Making; D004636:Emergency Service, Hospital; D006801:Humans
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; D002116:Calcitonin