Abstract
BackgroundThis randomized controlled trial aimed to evaluate whether the serum procalcitonin (PCT) level can be utilized to guide the use of antibiotics in the treatment of acute exacerbations of asthma.MethodsA total of 293 consecutive patients with suspected asthma attacks from February 2005 to July 2010 participated in this study. 225 patients completed the study. Serum PCT levels, and other inflammatory biomarkers of all patients were measured. In addition to the standard treatment, the control group received antibiotics according to the attending physicians’ discretions, while the patients in the PCT group were treated with antibiotics according to serum PCT concentrations. Antibiotics usage was strongly discouraged when the PCT concentration was below 0.1 μg/L; discouraged when the PCT concentration was between 0.1 μg/L and 0.25 μg/L; or encouraged when the PCT concentration was above 0.25 μg/L. The primary endpoint was the determination of antibiotics usage. The second endpoints included the diagnostic accuracy of PCT and other laboratory biomarkers the effectiveness of asthma control, secondary ED visits, hospital re-admissions, repeated needs for steroids or dosage increase, needs for antibiotics, WBC count, PCT levels and FEV1%.ResultsAt baseline, two groups were identical regarding clinical, laboratory and symptom score. Probability of the antibiotics usage in the PCT group (46.1%) was lower than that in the control group (74.8%) (χ2 = 21.97, p < 0.001. RR = 0.561, 95% CI 0.441-0.713). PCT and IL-6 showed good diagnostic significance for bacterial asthma (r = 0.705, p = 0.003). The degrees of asthma control in patients were categorized to three levels and were comparable between the two groups at the six weeks follow-up period (χ2 = 1.62, p = 0.45). There were no significant difference regarding other secondary outcomes (p > 0.05).ConclusionsThe serum PCT concentration can be used to effectively determine whether the acute asthma patients have bacterial infections in the respiratory tract, and to guide the use of antibiotics in the treatment of acute asthma exacerbations, which may substantially reduce unnecessary antibiotic use without compromising the therapeutic outcomes.Trial registrationICTRP ChiCTR-TRC-12002534
Highlights
This randomized controlled trial aimed to evaluate whether the serum procalcitonin (PCT) level can be utilized to guide the use of antibiotics in the treatment of acute exacerbations of asthma
This study aimed to investigate whether the serum PCT level has diagnostic potential for bacterial asthma attack, and can serve to guide the use of antibiotics in the management of acute exacerbations of asthma
This study showed that PCT test could help physicians to determine whether patients were suffering from respiratory tract bacterial infections
Summary
This randomized controlled trial aimed to evaluate whether the serum procalcitonin (PCT) level can be utilized to guide the use of antibiotics in the treatment of acute exacerbations of asthma. Acute attacks of asthma are episodes that occur suddenly and may occur repeatedly over time. There are various causes for acute asthma, including allergen provocation, drugs, respiratory viruses, bacterial infections and so on. Since bacterial infection seems to only play a minor role in acute exacerbations of asthma, guidelines for asthma management do not recommend routine use of antibiotics [1]. The majority of patients with acute asthma are treated with a number of conventional treatment measures, including repetitive administration of rapid-acting inhaled bronchodilator, introduction of systemic glucocorticosteroids, oxygen supplementation and so on, to alleviate the symptoms. Most patients are treated with antibiotics, leading to antibiotics abuse and bacterial resistance [2]
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