In the Journals

Procalcitonin-guided algorithm safely reduces duration of antibiotic therapy

Jennifer Townsend, MD,
Jennifer Townsend

The use of a procalcitonin-guided algorithm reduces the duration of antibiotic therapy among patients with lower respiratory tract infections without increasing adverse outcomes, according to study results published in Open Forum Infectious Diseases.

“We did a prospective evaluation of procalcitonin, comparing it to a preintervention group,” Jennifer Townsend, MD, director of antimicrobial stewardship and medical director of outpatient parenteral antibiotic therapy in the division of infectious diseases at Johns Hopkins Bayview Medical Center, told Infectious Disease News. “Procalcitonin is very helpful in lower respiratory tract infections in differentiating [between] viral and bacterial infections and helping to guide antibiotic therapy.”

According to Townsend and colleagues, lower respiratory tract infections account for much of the unnecessary antibiotic use in the inpatient setting. Procalcitonin, a biomarker that indicates the body’s response to bacterial infections, has been shown to be useful in guiding antibiotic therapy among patients with respiratory infections.

Although procalcitonin-guided antibiotic therapy has demonstrated significant reductions in antibiotic use without increasing adverse outcomes among patients with lower respiratory tract infections in European trials, Townsend and colleagues said the intervention has not been widely studied in the U.S..

They conducted a pre-post trial that compared patients receiving procalcitonin-guided antibiotic therapy with a control group of patients receiving standard care. For the intervention group, Townsend and colleagues enrolled 174 patients from April 17 to Nov. 29, 2017, who were admitted to medicine services and received antibiotics for lower respiratory tract infections. During the intervention, providers were encouraged to discontinue antibiotics based on the procalcitonin algorithm, Townsend and colleagues said. The control group was composed of 200 patients who were admitted in the 5-plus months before the intervention.

The reported primary endpoint was median antibiotic duration. Townsend and colleagues also assessed adverse outcomes at 30 days, including death, transfer to an ICU, antibiotic side effects, Clostridioides difficile infection, disease-specific complications and post-discharge antibiotic prescription for a lower respiratory tract infection.

According the study, in 75% of encounters, providers complied with the procalcitonin algorithm. The median antibiotic duration for pneumonia was reduced from 7 days to 6 (P = .045) as a result of procalcitonin-guided therapy. Townsend and colleagues also observed that the guided therapy reduced the median antibiotic duration for acute exacerbation of chronic obstructive pulmonary disease from 4 days to 3 (P = .01). They reported no observable difference in the rate of adverse outcomes in the intervention group compared with the control group.

“It’s very useful for diagnostic uncertainty,” Townsend said. “As for personalized medicine, you’re not treating every patient the same; you treat them based on the bacterial burden that they have. In that way, it’s a lot more precise than just one size fit all.” – Marley Ghizzone

Disclosures: Townsend reports receiving a grant from Brahms GmbH to conduct the study.

Jennifer Townsend, MD,
Jennifer Townsend

The use of a procalcitonin-guided algorithm reduces the duration of antibiotic therapy among patients with lower respiratory tract infections without increasing adverse outcomes, according to study results published in Open Forum Infectious Diseases.

“We did a prospective evaluation of procalcitonin, comparing it to a preintervention group,” Jennifer Townsend, MD, director of antimicrobial stewardship and medical director of outpatient parenteral antibiotic therapy in the division of infectious diseases at Johns Hopkins Bayview Medical Center, told Infectious Disease News. “Procalcitonin is very helpful in lower respiratory tract infections in differentiating [between] viral and bacterial infections and helping to guide antibiotic therapy.”

According to Townsend and colleagues, lower respiratory tract infections account for much of the unnecessary antibiotic use in the inpatient setting. Procalcitonin, a biomarker that indicates the body’s response to bacterial infections, has been shown to be useful in guiding antibiotic therapy among patients with respiratory infections.

Although procalcitonin-guided antibiotic therapy has demonstrated significant reductions in antibiotic use without increasing adverse outcomes among patients with lower respiratory tract infections in European trials, Townsend and colleagues said the intervention has not been widely studied in the U.S..

They conducted a pre-post trial that compared patients receiving procalcitonin-guided antibiotic therapy with a control group of patients receiving standard care. For the intervention group, Townsend and colleagues enrolled 174 patients from April 17 to Nov. 29, 2017, who were admitted to medicine services and received antibiotics for lower respiratory tract infections. During the intervention, providers were encouraged to discontinue antibiotics based on the procalcitonin algorithm, Townsend and colleagues said. The control group was composed of 200 patients who were admitted in the 5-plus months before the intervention.

The reported primary endpoint was median antibiotic duration. Townsend and colleagues also assessed adverse outcomes at 30 days, including death, transfer to an ICU, antibiotic side effects, Clostridioides difficile infection, disease-specific complications and post-discharge antibiotic prescription for a lower respiratory tract infection.

According the study, in 75% of encounters, providers complied with the procalcitonin algorithm. The median antibiotic duration for pneumonia was reduced from 7 days to 6 (P = .045) as a result of procalcitonin-guided therapy. Townsend and colleagues also observed that the guided therapy reduced the median antibiotic duration for acute exacerbation of chronic obstructive pulmonary disease from 4 days to 3 (P = .01). They reported no observable difference in the rate of adverse outcomes in the intervention group compared with the control group.

“It’s very useful for diagnostic uncertainty,” Townsend said. “As for personalized medicine, you’re not treating every patient the same; you treat them based on the bacterial burden that they have. In that way, it’s a lot more precise than just one size fit all.” – Marley Ghizzone

Disclosures: Townsend reports receiving a grant from Brahms GmbH to conduct the study.