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The Use of Procalcitonin to Reduce Inappropriate Antibiotic Usage in Respiratory Tract Infections

Posted Oct 05 2009 10:02pm

Serum procalcitonin levels have been shown in the past to be elevated with bacterial infections but not with viral infections. It's important for physicians to be able to distinguish between these two types of infections because antibiotics are often the treatment of choice in the former but ineffective in the latter. Appropriate use of antibiotics can reduce the cost of care and also the likelihood of the emergence of antibiotic-resistant bacterial strains. A recent article revealed some new findings in this area of inquiry (see: Procalcitonin measurement may help reduce antibiotics overuse for lower respiratory tract infections ). Below is an excerpt from the article:

The use of guidelines for treatment of lower respiratory tract infections such as bronchitis and pneumonia determined by measurements of a chemical in the blood known as procalcitonin [PCT] resulted in lower rates of antibiotic use and associated adverse effects, and similar rates of adverse outcomes compared to standard guidelines, according to a study in the September 9 issue of JAMA....[C]linical signs and symptoms are unreliable in distinguishing viral from bacterial LRTI [lower respiratory tract infections], and that as many as 75 percent of patients with LRTI are treated with antibiotics despite the predominantly viral origin of their infection....The researchers found that “the rate of overall adverse outcomes was similar in the PCT and control groups ....The mean [average] duration of antibiotics exposure in the PCT vs. control groups was lower in all patients ...and in the subgroups of patients with community-acquired pneumonia, ..., exacerbation of chronic obstructive pulmonary disease..., and acute bronchitis....Antibiotic-associated adverse effects were less frequent in the PCT group." .... PCT guidance will have substantial clinical and public health implications to reduce antibiotic exposure and associated risks of adverse effects and antibiotic resistance.

I have discussed the term comparative effectiveness in previous notes as well as the key role of clinical lab testing for monitoring the effectiveness of various therapies (see: The Inclusion of Molecular Diagnostic Testing in Comparative Effectiveness Studies; Moving Resources from the Therapeutic to the Diagnostic Silo; Biomarkers Used to Assess Treatment Efficacy ). The use of procalcitonin in the manner described about is another good example of how lab tests can be used in this way in the health delivery system. Procalcitonin can also be used to diagnose septicemia in intensive care units for patients suffering traumatic injuries (see: Procalcitonin can also be used to diagnose septicemia in trauma intensive care units ). This latter article makes reference to the semiquantitative PCT-Q test, which is highly specific but far less sensitive than the LUMItest PCT, also available from Brahms International. Point-of-care availability of one of them would be necessary for the test to be useful in the triage of LRTI. Twenty minutes is cited as the time required for test result availability in the JAMA article above.

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