Skip to main content

Table 2 Role of biomarkers in the initiation of antibiotic therapy for lower respiratory tract infection

From: Role of biomarkers in the management of antibiotic therapy: an expert panel review II: clinical use of biomarkers for initiation or discontinuation of antibiotic therapy

Biomarker Study (ref) Study design Nb patients, n (setting) Level of evidence End-point Main results, absolute risk reduction (ARR) or odds ratio (OR; 95% CI)
  1 st author, [Ref]      
PCT Stolz D, [20] Single-centre, randomised, controlled open study 208 High Antibiotic exposure and rate of initiation of antibiotic therapy, based on PCT level > 0.25 μg/L ARR = 32% (40% vs. 72%) of antibiotic prescriptions in the PCT-guided group.
    (AECB)    
       Ab exposure OR = 0.56 [0.43-0.73]
PCT Schuetz P, [25] Multicentre, open RCT 1359 High Antibiotic exposure ARR = 12% (75.4% vs. 87.7%) in PCT group, Overall antibiotic exposure = - 35% (5.7 vs. 8.7 days).
   Noninferiority study (ED)   Based on a PCT level > 0.25 μg/L for initiating prescription.  
PCT Christ-Crain M, [18] Single-centre open RCT 302 High Antibiotic initiation rate ARR = 14% (85% vs. 99%) in initial antibiotic prescription in PCT group
    (ED, ward)   Antibiotic exposure  
      Based on a PCT level > 0.25 μg/L to initiate therapy Overall ab exposure: OR = 0.52 [0.48–0.55]
PCT Kristoffersen KB, [19] Single-centre, open, RCT 210 High Antibiotic prescription rate, based on a PCT level > 0.25 μg/L to initiate therapy in PCT group 3% increase in antibiotic prescription (88% vs. 85%) in the PCT group
    (ED, ward)    
PCT Long W, [23] Single-centre, open RCT 127 High Antibiotic prescription rate, based on a PCT level > 0.25 μg/L in the PCT group ARR = 11% of antibiotic prescriptions in the PCT group
    (ED)    
PCT Long W, [22] Single-centre, open RCT 156 High Antibiotic prescription rate, based on a PCT level > 0.25 μg/L in the PCT group ARR = 13% of antibiotic prescriptions in the PCT group
    (ED)    
PCT Burkhardt O, [16] Single-centre, open RCT, noninferiority 550 High Antibiotic prescription rate, based on a PCT level > 0.25 μg/L in the PCT group ARR = 15% (21.5% vs. 36.7%) for antibiotic prescription rate in the PCT group
    (PC)    
PCT Briel M, [15] Multicentre, open RCT, noninferiority 458 High Antibiotic prescription rate, based on a PCT level > 0.25 μg/L in the PCT group ARR = 72% [95% CI 66-78] for antibiotic prescription rate in the PCT group
    (PC)    
PCT Schuetz P, [30] Meta-analysis of 14 RCTs 3 119 High   Risk reduction of initial antibiotic therapy: OR = 0.24 (95% CI, 0.2-0.29)
       Overall antibiotic exposure:
       OR = 0.1 (95% CI = 0.07-0.14), without difference in mortality rates
PCT Van der Meer V, [28] Literature review on the use of CRP (13 studies) 13 High Prediction of LRTI Bacterial LRTI predicted with a sensitivity varying from 8% to 99% and a specificity varying from 27% to 95%
PCT Schuetz P, [29] Review of 8 RCTs using an PCT-based algorithm for the initiation of antibiotic therapy 3 457 High Antibiotic prescription rate ARR varying from 6% to 72%
CRP Cals JW, [24] Multicentre, open cluster-RCT, testing a CRP-based algorithm 431 High Antibiotic prescription rate and antibiotic exposure, based on a CRP value < 20 : no antibiotic; CRP >100 : atb recommended, and 20<CRP<99 : reassess for possible therapy ARR = 22% (31% vs. 53%) of initial antibiotic prescriptions in the CRP group
       Overall antibiotic exposure: - 13% (45% vs. 58%)
PCT Christ-Crain M, [17] Multicentre, open, cluster-RCT 243 High Antibiotic prescription rate, based on a PCT level > 0.25 μg/L in the PCT group ARR = 39% for antibiotic prescription rate in the PCT group
    (ED)    
Summary of evidence table: Lower respiratory tract infection
Number of studies, n Total number of patients, n Highest level of evidence Directness* Consistency** Overall strength of evidence
12 4 412 High Yes Yes Strong
  1. *Directness: studies provide evidence of a direct association between a treatment or a given risk factor and a judgment criterion.
  2. **Consistency: results from studies of similar level of evidence are not contradictory.