Determination of procalcitonin levels reduces prescription of antibiotics for lower respiratory tract infections
Measuring procalcitonin levels can reduce the unreasonable prescription of antibiotics for lower respiratory tract infections.
Results of a study published in the February issue of Lancet show that measuring procalcitonin levels can reduce the unreasonable use of antibiotics for lower respiratory infections (LRA).
Antibacterial therapy for INDI is often prescribed until the bacterial etiology of the disease is confirmed. It is also known that with bacterial infections, the level of precursors of serum calcitonin, in particular procalcitonin, increases.
To determine medical tactics to reduce consumption of antibiotics for AIDS and reduce the likelihood of spreading resistant bacteria due to an unreasonable prescription of antibiotics, a sensitive new method for rapid diagnosis of serum levels of procalcitonin was evaluated.
In total, during the study period, 243 patients with IDP were admitted to hospital, of whom 119 received empirical antibiotic therapy and 124 patients received antibiotics after determining the level of procalcitonin. If the serum procalcitonin concentration range was 0.1-0.25 μg / l, antibiotic therapy was not recommended if the procalcitonin concentration range reached 0.25-0.5 μg / l, the researchers recommended the appointment of antibiotics. A clinical evaluation of the condition in the two randomized groups was carried out after 6 to 24 hours.
The diagnosis of pneumonia was clinically confirmed in 87 (36%) patients, exacerbation of chronic bronchitis in 60 (25%) patients, acute bronchitis in 59 (24%) patients, bronchial asthma in 13 (5%) patients and other diseases was diagnosed in 24 (10%) patients. Of the 175 patients who underwent serological testing, 141 (81%) had an etiology of the virus. Sputum microbiological examination was positive in 51 (21%) patients and blood in 16 (7%) patients.
Compared to patients randomized to the empirical antibacterial treatment group, the relative risk established in the group of patients receiving antibiotics after measuring the procalcitonin level was 0.49 (95% confidence interval 0.44-0, 55, p less than 0.0001). A decrease in the prescription of antibiotics was reported in all diagnostic subgroups. The clinical and biological parameters at discharge were the same in the two groups, and the result was judged favorable in 235 (97%) patients.
However, given the small sample size and the single-blind nature of the study, the authors caution that additional clinical studies are required to reach a final conclusion on the effectiveness of the method.
Commenting on the results, the researchers report that the rapid diagnosis of procalcitonin to decide on the prescription of antibiotics reduced the use of this group of LDPE drugs by 50%. In addition, the rejection of the empirical prescription for antibiotic therapy did not affect the outcome of the disease. Given the frequent and inadequate use of antibiotics for non-bacterial lower respiratory tract infections, the appointment of a treatment taking into account the measurement of procalcitonin levels has clinical and economic indications.