Procalcitonin for selecting the antibiotic regimen in outpatients with low-risk community-acquired pneumonia using a rapid point-of-care testing: A single-arm clinical trial

Abstract

ObjectiveWe aimed to assess the role of procalcitonin (PCT) to guide the initial selection of the antibiotic regimen for low-risk community-acquired pneumonia (CAP).MethodsA single-arm clinical trial was conducted including outpatients with CAP and Pneumonia Severity Index risk classes I-II. Antimicrobial selection was based on the results of PCT measured with a rapid point-of-care testing. According to serum PCT levels, patients were assigned to two treatment strategies: oral azithromycin if PCT was <0.5 ng/ml, or levofloxacin if levels were ≥0.5 ng/ml. Primary outcome was clinical cure rate. Short-term and long-term outcomes were assessed. Results were compared with those of a historical standard-of-care control-group treated in our centre.ResultsOf 253 subjects included, 216 (85.4%) were assigned to azithromycin. Pneumococcal infection was diagnosed in 26 (12%) and 21 (56.8%) patients allocated to azithromycin and levofloxacin groups, respectively. No patients in the azithromycin group developed bacteraemia. Atypical organisms were more common in patients given azithromycin (18.5% vs 8.1%, respectively). The majority (93%) of patients with atypical pneumonia had low PCT levels. Clinical cure rates were 95.8% in the azithromycin group, 94.6% in the levofloxacin group, and 94.4% in the historical control group. No 30-day mortality or recurrences were observed, and the 3-year rates of recurrence and mortality were very low in both groups. Adverse events occurrence was also infrequent.ConclusionA PCT-guided strategy with a rapid point-of-care testing safely allowed selecting empirical narrow-spectrum antibiotics in outpatients with CAP.Trial registrationThe study is registered with ClinicalTrials.gov, number NCT02600806

Determining best outcomes from community‐acquired pneumonia and how to achieve them

“…If it is low it suggests viral pneumonia or an alternative diagnosis and improvement in PCT indicates clinical stability and guides decisions to step down to oral antibiotics . Masia et al . assessed the role of PCT with rapid point‐of‐care testing to guide treatment in low risk CAP by giving azithromycin if PCT was <0.5 ng/mL and levofloxacin if PCT was >0.5 ng/mL and found similar clinical cure rates between groups and when compared to historical controls.…”

“…If it is low it suggests viral pneumonia or an alternative diagnosis 56 and improvement in PCT indicates clinical stability and guides decisions to step down to oral antibiotics. 57,58 Masia et al 59 assessed the role of PCT with rapid point-of-care testing to guide treatment in low risk CAP by giving azithromycin if PCT was <0.5 ng/mL and levofloxacin if PCT was Table 2 Recommended actions to help achieve the best outcomes from CAP Use a risk stratification tool: CURB-65, PSI, IDSA/ATS criteria. 52,53 Procalcitonin can assist with diagnosis, and treatment response.…”

Evaluation of the Virclia® automated chemiluminescent immunoassay system for diagnosing pneumonia caused by Mycoplasma pneumoniae

“…The study was approved by the ethics committee of the hospital (CEIC) and was registered in ClinicalTrials.gov , No. NCT02600806 . The serological studies were performed at the Microbiology Service of Hospital San Juan de Alicante (Alicante, Spain).…”

The next generation of rapid point-of-care testing identification tools for ventilator-associated pneumonia

“…PCT could be an interesting tool to discontinue antimicrobial therapy safely in the ICU according to recent studies (24,25), and as such could represent a potential candidate as a POCT tool. POCT to laboratory testing correlation seems to be sufficient (26), but there is no available data regarding its use for VAP, and few results are available for communityacquired pneumonia (27).…”