Procalcitonin guided antibiotic therapy of acute exacerbations of asthma: a randomized controlled trial

Abstract

BackgroundThis randomized controlled trial aimed to evaluate whether the serum procalcitonin (PCT) level can be utilized to guide the use of antibiotics in the treatment of acute exacerbations of asthma.MethodsA total of 293 consecutive patients with suspected asthma attacks from February 2005 to July 2010 participated in this study. 225 patients completed the study. Serum PCT levels, and other inflammatory biomarkers of all patients were measured. In addition to the standard treatment, the control group received antibiotics according to the attending physicians’ discretions, while the patients in the PCT group were treated with antibiotics according to serum PCT concentrations. Antibiotics usage was strongly discouraged when the PCT concentration was below 0.1 μg/L; discouraged when the PCT concentration was between 0.1 μg/L and 0.25 μg/L; or encouraged when the PCT concentration was above 0.25 μg/L. The primary endpoint was the determination of antibiotics usage. The second endpoints included the diagnostic accuracy of PCT and other laboratory biomarkers the effectiveness of asthma control, secondary ED visits, hospital re-admissions, repeated needs for steroids or dosage increase, needs for antibiotics, WBC count, PCT levels and FEV1%.ResultsAt baseline, two groups were identical regarding clinical, laboratory and symptom score. Probability of the antibiotics usage in the PCT group (46.1%) was lower than that in the control group (74.8%) (χ2 = 21.97, p < 0.001. RR = 0.561, 95% CI 0.441-0.713). PCT and IL-6 showed good diagnostic significance for bacterial asthma (r = 0.705, p = 0.003). The degrees of asthma control in patients were categorized to three levels and were comparable between the two groups at the six weeks follow-up period (χ2 = 1.62, p = 0.45). There were no significant difference regarding other secondary outcomes (p > 0.05).ConclusionsThe serum PCT concentration can be used to effectively determine whether the acute asthma patients have bacterial infections in the respiratory tract, and to guide the use of antibiotics in the treatment of acute asthma exacerbations, which may substantially reduce unnecessary antibiotic use without compromising the therapeutic outcomes.Trial registrationICTRP ChiCTR-TRC-12002534

Procalcitonin testing to guide antibiotic therapy for the treatment of sepsis in intensive care settings and for suspected bacterial infection in emergency department settings: a systematic review and cost-effectiveness analysis

“…Eight studies were conducted in ICU settings 33,37,41,45,50,52,54,61 and all of these studies included only adult participants; we did not identify any studies conducted in paediatric ICU settings that met the inclusion criteria for this review. Ten studies 39,42,44,49,[55][56][57]60,62,69 were conducted in ED settings, of which eight included only adults 42,44,[55][56][57]60,62,69 and two included only children. 39,49 The majority (12 37,39,41,42,44,49,52,57,[60][61][62]69 ) of the included studies measured plasma/serum PCT levels using the BRAHMS PCT Sensitive Kryptor assay (Thermo Fisher Scientific Inc., Waltham, MA, USA).…”

“…45,50 The remaining four studies used quantitative PCT assays, but did not specify the assay manufacturer; 33,54-56 two of these studies were published as conference abstracts only, 55,56 and one was a Chinese-language publication. 54,62 were conducted in China, and one study 45 was conducted in Brazil; no UK studies were identified. The two studies 55,56 that were published as conference abstracts did not specify location.…”

“…The two studies 55,56 that were published as conference abstracts did not specify location. Nine 37,39,41,42,44,52,57,60,61 of the 18 included studies reported receiving some support from assay manufacturers, including supply of assay platforms and/or kits; five studies 33,49,54,62,69 were fully supported by public funding and four studies 45,50,55,56 did not report any information on funding.…”

“…Three 45,52,60 of the eighteen studies 33,37,39,41,42,44,45,49,50,52,[54][55][56][57][60][61][62]69 were judged at high risk of bias, one as low risk of bias, 62 and all other studies were judged at unclear risk of bias, as insufficient information was reported to make a judgement on one or more bias domains ( Figure 2 and Table 1). …”

Predictors of treatment failure and clinical stability in patients with community acquired pneumonia

“…Multiple large studies have shown that following a PCT algorithm is associated with a reduction in antibiotic use in pneumonia without increasing risk of complications. PCT is effective in rationalizing antibiotics in patients with COPD and asthma requiring hospital admission (68,69).…”