Background: Procalcitonin (PCT) is a marker for bacterial infection that can be used as a diagnostic tool to help distinguish viral from bacterial lower respiratory tract infections (LRTI). LRTI is a leading cause of illness in pediatrics worldwide. Most LRTIs in pediatrics are due to viral causes, yet conservative clinical guidelines advise empiric antibiotic therapy because there is no reliable method to determine the etiology of the illness. With the increasing threat of antibiotic resistance, efforts are underway to decrease the use of antibiotics. PCT-guided antibiotic therapy has shown a reduction in the use of antibiotics for adult LRTI. Can PCT-guided antibiotic treatment of LRTIs in a pediatric population reduce the antibiotic therapy duration rate or prescription rate with comparable outcomes to current therapy guidelines?
Method: An exhaustive search was conducted using Medline-OVID, CINAHL, and Web of Science using the keywords: procalcitonin, antibiotic, pediatrics, and lower respiratory tract infection. A search on the NIH clinical trials site revealed that there are no trials currently registered relating to the use of PCT-guided antibiotic therapy in pediatrics with lower respiratory tract infections. GRADE was used to assess the quality of relevant articles. Results: Included in this systematic review were two studies that met inclusion criteria. A randomized, multi-center clinical trial with 337 participants demonstrated a statistically significant reduction in the duration of antibiotic therapy, but an increase in the antibiotic prescription rate overall when applying PCT-guided antibiotic therapy. A randomized, single-center clinical trial with 310 participants demonstrated a statistically significant reduction in the duration of antibiotic therapy and antibiotic prescription rate when PCT-guided antibiotic therapy was applied.
Conclusion: PCT-guided antibiotic therapy has been shown to reduce the duration of antibiotic therapy. Furthermore, it is suggested that in less severe LRTI PCT-guided antibiotic therapy can reduce antibiotic prescription rates in a pediatric population. More randomized control trials are needed to increase the statistical power behind these findings. There was no evidence of increased risk of disease-specific adverse events. At this time PCT-guided therapy is recommended to reduce the duration of antibiotic therapy.
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