Procalcitonin-Guided Use of Antibiotics for Lower Respiratory Tract Infection.

The New England Journal of Medicine
David T HuangProACT Investigators

Abstract

The effect of procalcitonin-guided use of antibiotics on treatment for suspected lower respiratory tract infection is unclear. In 14 U.S. hospitals with high adherence to quality measures for the treatment of pneumonia, we provided guidance for clinicians about national clinical practice recommendations for the treatment of lower respiratory tract infections and the interpretation of procalcitonin assays. We then randomly assigned patients who presented to the emergency department with a suspected lower respiratory tract infection and for whom the treating physician was uncertain whether antibiotic therapy was indicated to one of two groups: the procalcitonin group, in which the treating clinicians were provided with real-time initial (and serial, if the patient was hospitalized) procalcitonin assay results and an antibiotic use guideline with graded recommendations based on four tiers of procalcitonin levels, or the usual-care group. We hypothesized that within 30 days after enrollment the total antibiotic-days would be lower - and the percentage of patients with adverse outcomes would not be more than 4.5 percentage points higher - in the procalcitonin group than in the usual-care group. A total of 1656 patients were included...Continue Reading

Associated Clinical Trials

May 6, 2014·David T. Huang, MD, MPHDavid T. Huang, MD, MPH

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