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

Quenot, Jean-Pierre; Luyt, Charles-Edouard; Roche, Nicolas; Chalumeau, Martin; Charles, Pierre-Emmanuel; Claessens, Yann-Eric; Lasocki, Sigismond; Bedos, Jean-Pierre; Péan, Yves; Philippart, François; Ruiz, Stéphanie; Gras-Leguen, Christele; Dupuy, Anne-Marie; Pugin, Jérôme; Stahl, Jean-Paul; Misset, Benoit; Gauzit, Rémy; Brun-Buisson, Christian

doi:10.1186/2110-5820-3-21

Annals of Intensive Care

Table 5 PCT-based algorithms used for discontinuing antibiotic therapy in randomized, clinical trials

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

Author [ref], acronym	Setting	Population	Number of patients	Algorithm used
Emergency department and ambulatory care
Christ-Crain [18], ProCAP trial	Emergency room	CAP	302	PCT measured d4, d6, d8
			- 151 PCT-guided arm	Stopping antibiotics encouraged if PCT < 0.25μg/L; strongly encouraged if PCT < 0.1 μg/L
			- 151 control arm	If initial PCT >10μg/L, stop when decreased by ≥90%
Briel [15]	Ambulatory care	Lower RTI	458	PCT at d3
			- 232 PCT-guided arm	Encourage stopping if PCT d3 ≤ 0.25 μg/L
			- 226 control arm	Encourage stopping if PCT d3 ≤ 0.25 μg/L
Schuetz [25]	Emergency room	Upper & lower RTI	1359	PCT at d3, d5, d7 if patient still hospitalised
			- 671 PCT-guided arm	Stop antibiotics when PCT ≤ 0.25 μg/L
			- 671 PCT-guided arm	If initial PCT >10 μg/L, stop when decreased by ≥80%
			- 688 control arm	If initial PCT >10 μg/L, stop when decreased by ≥80%
Long W [22]	Emergency room	CAP	172	PCT at d1, d3, d6, & d8
			- 86 PCT-guided arm	Stop when PCT ≤ 0.25 μg/L
			- 86 control arm	Stop when PCT ≤ 0.25 μg/L
Intensive care unit
Nobre [35]	ICU	Severe sepsis & septic shock	79	PCT d1 > 1 μg/l :
			- 39 PCT-guided arm	• Stop if PCT d5 decreased by > 90% or PCT < 0.25 μg/L
			- 40 control arm	PCT d1 < 1μg/l :
			- 40 control arm	• Stop if PCT d3 < 0.1 μg/l (but not before d5 if bacteremia)
Hochreiter [70]	ICU	Sepsis	110	Stop if clinical symptoms resolved and PCT < 1 μg/L (or dropped by 25% - 35% over 3 days if initial PCT > 1 μg/L)
		(Infection + 2 SIRS criteria)	- 57 PCT-guided arm
		(Infection + 2 SIRS criteria)	- 53 control arm
Schroeder [73]	ICU	Severe sepsis after abdominal surgery	27	Stop if clinical symptoms resolved and PCT < 1 μg/L (or dropped by 25% - 35% over 3 days if initial PCT > 1 μg/L)
			- 14 PCT-guided arm
			- 13 control arm
Stolz [69], ProVAP trial	ICU	VAP	101	Daily PCT measurements PCT from d3 on
			- 51 PCT-guided arm	Stop when PCT < 0.5 μg/L or dropped by ≥ 80% from initial value but stopping discouraged if PCT >1 μg/L
			- 50 control arm
Bouadma [33], PRORATA trial	ICU	Sepsis, severe sepsis	621	Daily PCT measurements from d3 on
			- 307 PCT-guided arm	Stop when PCT < 0.5 μg/L or dropped by ≥ 80% from initial value
			- 314 control arm

CAP community-acquired pneumonia, ICU intensive care unit, PCT procalcitonin, RTI respiratory tract infection, SIRS systemic inflammatory response syndrome, VAP ventilator-associated pneumonia.

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