Procalcitonin guidance significantly reduces antibiotic duration in community-acquired pneumonia: the 'ProCAP' study

Background

Community-acquired pneumonia (CAP) is routinely treated with antibiotic courses of 10–14 days. Procalcitonin (ProCT) is elevated in systemic bacterial infections, but remains low in viral infections. Its potential as a tool to guide AB prescription in lower respiratory tract infections has been shown [1]. This study aims to evaluate ProCT stewardship to reduce AB duration in patients with CAP.

Methods

From a prospective, single-blinded, randomized study, data of 200 patients with CAP were analyzed. The standard group (n = 101) received antibiotics as generally recommended. In the ProCT group (n = 99), ProCT levels were measured at days 4, 6 and 8 and antibiotic therapy was discontinued if levels were < 0.25 μg/l, measured with a sensitive assay (Kryptor PCT, BRAHMS, Germany). At baseline and at follow-up at 6 weeks, a standardized work-up was performed.

Results

Baseline characteristics in both groups (Standard/ProCT) were similar (P values of quality of life score [41 ± 22/43 ± 21], temperature [38 ± 1/38 ± 1], leucocytes [13 ± 6/14 ± 7], C-reactive protein [160 ± 95/142 ± 120] and ProCT [median: 0.4/0.6] were not significant). Fifty-eight percent of patients had a high (class IV, V) pneumonia severity index. In the standard group, the mean duration of antibiotic therapy was 14.2 ± 7.3 days as compared with 6.2 ± 6.2 days in the ProCT group (P < 0.001). A total 99.5% of patients underwent a follow-up. There were no differences in clinical, radiographic and laboratory outcome data as well as in mortality (14.5%) between groups.

Conclusions

The duration of antibiotic treatment in patients with CAP can be markedly and safely reduced using a ProCT-guided treatment algorithm, with similar outcome. In view of the increasing antimicrobial resistance and costs, these findings have important clinical implications.