Procalcitonin guidance for reduction of antibiotic use in patients hospitalized with severe acute exacerbations of asthma: a randomized controlled study with 12-month follow-up.

Wei Long,Xue-Min Zhang,Gang Lu,Jian-Guo Tang,Yu Zhang,Yi-Cui Zhang,Li-Juan Li,Gao-Zhong Huang

doi:10.1186/s13054-014-0471-7

Abstract

IntroductionPatients with severe acute exacerbations of asthma often receive inappropriate antibiotic treatment. We aimed to determine whether serum procalcitonin (PCT) levels can effectively and safely reduce antibiotic exposure in patients experiencing exacerbations of asthma.MethodsIn this randomized controlled trial, a total of 216 patients requiring hospitalization for severe acute exacerbations of asthma were screened for eligibility to participate and 169 completed the 12-month follow-up visit. Patients were randomized to either PCT-guided (PCT group) or standard (control group) antimicrobial therapy. In the control group, patients received antibiotics according to the attending physician’s discretion; in the PCT group, patients received antibiotics according to an algorithm based on serum PCT levels. The primary end point was antibiotic exposure; secondary end points were clinical recovery, length of hospital stay, clinical and laboratory parameters, spirometry, number of asthma exacerbations, emergency room visits, hospitalizations and need for corticosteroid use due to asthma.ResultsPCT guidance reduced antibiotic prescription (48.9% versus 87.8%, respectively; P < 0.001) and antibiotic exposure (relative risk, 0.56; 95% confidence interval, 0.44 to 0.70; P < 0.001) compared to standard therapy. There were no significant differences in clinical recovery, length of hospital stay or clinical, laboratory and spirometry outcomes in both groups. Number of asthma exacerbations, emergency room visits, hospitalizations and need for corticosteroid use due to asthma were similar during the 12-month follow-up period.ConclusionA PCT-guided strategy allows antibiotic exposure to be reduced in patients with severe acute exacerbation of asthma without apparent harm.Trial registrationChinese Clinical Trial Register ChiCTR-TRC-12002534 (registered 26 September 2012)

Highlights

Patients with severe acute exacerbations of asthma often receive inappropriate antibiotic treatment
We demonstrated that PCT can be used accurately and effectively to determine whether acute asthma patients have bacterial infections and to guide the use of antibiotics in the treatment of acute exacerbation of mild to moderate asthma [5]
A single antibiotic was used in 108 patients (PCT group, 38 cases; control group, 70 cases; P = 0.715), and combination therapy with two or more antibiotics was administered in 15 patients (PCT group, 6 cases; control group, 9 cases; P = 0.715)

Summary

Introduction

Patients with severe acute exacerbations of asthma often receive inappropriate antibiotic treatment. Acute exacerbations of asthma account for nearly 2 million emergency department (ED) visits and 500,000 admissions each year in the United. In countries with high prescription rates for antibiotics, many asthma patients with exacerbations are treated with antibiotics, leading to antibiotic overuse and bacterial resistance [5,6,7]. In the United States, approximately 22% of acute asthma patients in the ED receive an antibiotic unnecessarily [7]. In England, a high antibiotic prescription rate (57%) was observed in asthma patients [6]. In our previous study in China, about 70% of patients with mild to moderate acute exacerbation of asthma received antibiotics [5]

Objectives

Methods

Results

Discussion

Conclusion