Saturday, July 28, 2018

Procalcitonin-guided therapy

R.E.B.E.L.EM - July 27, 2018
Article: Tupchong K, Chien C. Is procalcitonin useful in the diagnosis and treatment of acute respiratory infections in the Emergency Department? Ann Emerg Med 2018. PMID: 29459056
..."Authors’ Conclusions:
“A procalcitonin-guided approach to the initiation and discontinuation of antibiotics in acute respiratory infections has the potential to reduce antibiotic-related adverse effects and duration of therapy, but further study of emergency department (ED) patients is needed.”
Our Conclusions:
Procalcitonin-guided therapy may improve outcomes by reducing antibiotic exposure and adverse drug effects, but additional studies without significant industry bias are needed to determine effectiveness of procalcitonin-guided therapy on ED patients who are treated as outpatients.
Potential Impact to Current Practice:
Procalcitonin level may be a useful tool in the ED for antibiotic initiation in patient admitted for acute respiratory illnesses and can be trended by the inpatient team for decisions regarding duration of antibiotics.
Clinical Bottom Line:
Based on the available data, it may be reasonable to obtain a procalcitonin level for decisions regarding initiation of antibiotics in patients with acute respiratory illnesses in the ED if the patient is expected to be admitted. However, significant conflicts of interest cloud the actual utility of this marker and there is insufficient data on the role of procalcitonin and antibiotic initiation for patients who are discharged from the ED."