Abstract：Objective To evaluate the value of serum procalcitonin (PCT) for the guidance of antibiotic therapy in children with lower respiratory tract infection (LRTI). Methods A prospective randomized controlled study was conducted in 396 children with LRTI who visited Weifang Maternity and Child Care Hospital. The participants were randomly assigned into a PCT group in which the antibiotic therapy was guided by serum PCT level and a control group in which the standard therapy was given according to clinical guidance. Afterwards, a subgroup analysis was performed according to whether the patient was diagnosed with community-acquired pneumonia (CAP). After 14-day treatment, antibiotic prescription rate, duration of antibiotic treatment, and side events were compared between the groups. Results A total of 396 cases were recruited and equally assigned into the PCT group and the control group, among whom the numbers of the children with CAP were 125 and 123, respectively. The mean duration of antibiotic treatment was significantly shorter in the PCT group than in the control group (PPPConclusions Serum PCT-based guidelines on antibiotic use can shorten the duration of antibiotic therapy in children with LRTI.
DAI Bao-Quan,YUAN Xun-Tao,LIU Jin-Ming. Value of serum procalcitonin for the guidance of antibiotic therapy in children with lower respiratory tract infection[J]. CJCP, 2015, 17(12): 1292-1296.
Gerber JS, Prasad PA, Fiks AG, et al. Effect of an outpatient antimicrobial stewardship intervention on broad-spectrum antibiotic prescribing by primary care pediatricians:a randomized trial[J]. JAMA, 2013, 309(22):2345-2352.
[2]
Mangione-Smith R, Zhou C, Robinson JD, et al. Communication practices and antibiotic use for acute respiratory tract infections in children[J]. Ann Fam Med, 2015, 13(3):221-227.
[3]
Francis NA, Butler CC, Hood K, et al. Effect of using an interactive booklet about childhood respiratory tract infections in primary care consultations on reconsulting and antibiotic prescribing:a cluster randomised controlled trial[J]. BMJ, 2009, 339:b2885.
Esposito S, Tagliabue C, Picciolli I, et al. Procalcitonin measurements for guiding antibiotic treatment in pediatric pneumonia[J]. Respir Med, 2011, 105(12):1939-1945.
[7]
Stocker M, Fontana M, El Helou S, et al. Use of procalcitoninguided decision-making to shorten antibiotic therapy in suspected neonatal early-onset sepsis:prospective randomized intervention trial[J]. Neonatology, 2010, 97(2):165-174.
Baer G, Baumann P, Buettcher M, et al. Procalcitonin guidance to reduce antibiotic treatment of lower respiratory tract infection in children and adolescents (ProPAED):a randomized controlled trial[J]. PLoS One, 2013, 8(8):e68419.
[11]
Schuetz P, Kutz A, Grolimund E, et al. Excluding infection through procalcitonin testing improves outcomes of congestive heart failure patients presenting with acute respiratory symptoms:results from the randomized ProHOSP trial[J]. Int J Cardiol, 2014, 175(3):464-472.
[12]
Schuetz P, Christ-Crain M, Thomann R, et al. Effect of procalcitonin-based guidelines vs standard guidelines on antibiotic use in lower respiratory tract infections:the ProHOSP randomized controlled trial[J]. JAMA, 2009, 302(10):1059-1066.
British Thoracic Society Standards of Care Committee. British Thoracic Society Guidelines for the Management of Community Acquired Pneumonia in Childhood[J]. Thorax, 2002, 57(Suppl 1):i1-i24.
[15]
Nascimento-Carvalho CM, Cardoso MR, Barral A, et al. Procalcitonin is useful in identifying bacteraemia among children with pneumonia[J]. Scand J Infect Dis, 2010, 42(9): 644-649.
[16]
Don M, Valent F, Korppi M, et al. Differentiation of bacterial and vital community-acquired pneumonia in children[J]. Pediatr Int, 2009, 51(1):91-96.
[17]
Branche AR, Walsh EE, Vargas R, et al. Serum procalcitonin measurement and viral testing to guide antibiotic use for respiratory infections in hospitalized adults:a randomized controlled trial[J]. J Infect Dis, 2015, 212(11):1692-1700.
