Simple Blood Test May Guide Need for Antibiotic Treatment

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Doctors and patients looking for a way to reduce antibiotic exposure may now have help in the form of a simple blood test.

Philipp Schuetsz, MD and colleagues have published the results of a multicenter randomized trial reported in the Sept. 9 issue of the Journal of the American Medical Association which looked at the outcomes of treatment decisions based on the levels of serum procalcitonin.

The ProHOSP study involved 1,359 patients from six tertiary care hospitals in Switzerland who were treated at emergency rooms for a lower respiratory tract infection between October 2006 and March 2008. Patients were randomly assigned to get antibiotic treatment based on standard guidelines or an algorithm based on a serum procalcitonin (a simple blood test which took 20-minutes for results).

Procalcitonin is a marker of bacterial infection. Smaller past studies have shown it can safely guide antibiotic treatment decisions for patients with lower respiratory tract infections.

Antibiotics were encouraged for patients in the procalcitonin group when serum procalcitonin levels were higher than 0.5 micrograms per liter and encouraged if they were higher than 0.25 micrograms per liter. Antibiotics were strongly discouraged if the level was less than 0.1 micrograms per liter and discouraged if levels were 0.25 micrograms per liter or lower.

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Adverse outcomes of death, admission to the intensive care unit, disease-specific complications, or recurrent infection requiring antibiotic treatment within 30 days were similar in the procalcitonin and control groups, at 15.4% and 18.9%, respectively.

Those in the procalctonin group had a lower mean duration of antibiotic exposure of 5.7 days compared to 8.7 days in the control group.

Antibiotic-associated adverse effects were less frequent in the procalcitonin group than in the control group at 19.8% versus 28.1%, respectively

The study is a first step toward "tailored therapy" that would provide better care for patients "while promoting antibiotic stewardship for the entire population."

Sources
Schuetz P, et al "Effect of procalcitonin-based guidelines vs standard guidelines on antibiotic use in lower respiratory tract infections: The ProHOSP Randomized Controlled Trial" JAMA 2009; 302(10): 1059-1066.

Yealy DM, Fine, MJ "Measurement of serum procalcitonin: A step closer to tailored care for respiratory infections?" JAMA 2009; 302(10): 1115-116.

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