Title |
Do we need new trials of procalcitonin-guided antibiotic therapy?
|
---|---|
Published in |
Critical Care, January 2018
|
DOI | 10.1186/s13054-018-1948-6 |
Pubmed ID | |
Authors |
Thiago Lisboa, Jorge Salluh, Pedro Povoa |
Abstract |
Using biomarkers as a guide to tailor the duration of antibiotic treatment in respiratory infections is an attractive hypothesis assessed in several studies. Recent work aiming to summarize the evidence assessed the effect of a procalcitonin (PCT)-guided antibiotic treatment on outcomes in acute lower respiratory tract infections (LRTI), suggesting that significant reductions in antibiotic duration occur when using a PCT-guided algorithm. However, controversial evidence also suggested PCT-guided algorithms were associated with increased antibiotic duration and increased incidence of Clostridium difficile, without any impact on mortality, in real-world settings. So, although using PCT-guided antibiotic stewardship is promising, after more than a decade of randomized controlled trials on this topic the evidence in its favor is still less than compelling due to limitations in trial design, not taking into consideration fundamental aspects of PCT biology, and the absence of evidence-based antimicrobial duration in intervention and control groups. In this commentary we highlight some questions and limitations of primary PCT study data that might impact interpretation and clinical use of PCT at the bedside. |
X Demographics
Geographical breakdown
Country | Count | As % |
---|---|---|
United States | 8 | 11% |
Mexico | 6 | 9% |
Spain | 6 | 9% |
United Kingdom | 6 | 9% |
India | 3 | 4% |
Turkey | 3 | 4% |
Brazil | 3 | 4% |
Italy | 1 | 1% |
Chile | 1 | 1% |
Other | 9 | 13% |
Unknown | 24 | 34% |
Demographic breakdown
Type | Count | As % |
---|---|---|
Members of the public | 58 | 83% |
Practitioners (doctors, other healthcare professionals) | 7 | 10% |
Scientists | 3 | 4% |
Science communicators (journalists, bloggers, editors) | 2 | 3% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 49 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Other | 10 | 20% |
Student > Ph. D. Student | 6 | 12% |
Researcher | 5 | 10% |
Professor > Associate Professor | 5 | 10% |
Student > Postgraduate | 4 | 8% |
Other | 10 | 20% |
Unknown | 9 | 18% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 24 | 49% |
Pharmacology, Toxicology and Pharmaceutical Science | 3 | 6% |
Nursing and Health Professions | 2 | 4% |
Environmental Science | 1 | 2% |
Veterinary Science and Veterinary Medicine | 1 | 2% |
Other | 4 | 8% |
Unknown | 14 | 29% |