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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
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
If initial PCT >10 μg/L, stop when decreased by ≥80%
- 688 control arm
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
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 :
• 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
- 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
  1. CAP community-acquired pneumonia, ICU intensive care unit, PCT procalcitonin, RTI respiratory tract infection, SIRS systemic inflammatory response syndrome, VAP ventilator-associated pneumonia.