NEW YORK -- February 29, 2008 -- Researchers have reported that the use of an algorithm based on serial measurements of procalcitonin (PCT) allows for the reduction in duration and exposure of antibiotic therapy in patients with severe sepsis or septic shock. In addition the customised treatment regimen can shorten ICU stays and, consequently, lower hospital costs.
The study, published in the first March issue of the American Journal of Respiratory and Clinical Care Medicine, randomised 79 patients to receive a treatment course of antibiotics either according to standard treatment protocols or according to a decision algorithm based on measured blood levels of PCT. In those assigned to the intervention group, at the discretion of the physician, antibiotics were stopped when PCT levels had decreased 90 percent or more from the initial value, but not before day 3 if baseline PCT levels were less than 1 mug/L or day 5 if baseline PCT levels were greater than or equal to 1 mug/L.
In the analysis that included all 79 patients, the median treatment time for the PCT group was 3.5 fewer days than that of the control group, although the difference was not significant (P = .15). However, once the investigators controlled for early drop-outs, previously undiagnosed infections, and patients whose physicians declined to stop antibiotic treatment when the algorithm would have dictated it, results showed that patients treated according to the PCT algorithm had a significantly shorter treatment time at 6 days, than patients treated according to standard protocols, who averaged 12.5 days on antibiotics. A similar mortality and recurrence of the primary infection were observed in the two treatment groups.
Patients randomised to the PCT treatment also had a 2-day shorter intensive care unit stay (P = .03) than control patients, leading researchers to hypothesize that all infected patients could benefit from a personalised treatment and personalised treatment duration.
Three large multicenter trials with similar designs are currently ongoing in France, Denmark, and Germany; researchers are looking to their results to aid in determining whether a protocol of procalcitonin guidance is definitely safe and can be generalised worldwide.
Source: American Thoracic Society
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