Procalcitonin-guided algorithms of antibiotic therapy in community-acquired lower respiratory tract infections: a systematic review and meta-analysis of randomized controlled trials

Abstract

The aim of this study was to evaluate the efficacy and safety of procalcitonin-guided algorithms of antibiotic therapy in lower respiratory tract infections. Using procalcitonin, lower respiratory tract infections, community acquired pneumonia, exacerbations of COPD, exacerbations of chronic obstructive pulmonary diseases, acute bronchitis and asthma as key words, we searched relevant randomized controlled trials (RCT) from Pubmed, EMBASE, Cochrane Library, Chinese Journal Full-text Database, Chinese Biomedical Literature Database, and traced the related references to obtain the information that had not been found. The date of the search was from January of 1990 to December of 2010.We made quality assessment of qualified RCTs assessed by the exclusion and inclusion criteria and used RevMan 4.2.2 provided by the Cochrane Collaboration to perform meta-analysis. Five RCT involving 2322 patients were identified. There were significant differences between procalcitonin-guided treatment and standard treatment in duration of antibiotic treatment in days (WMD = -2.58 d, 95%CI: -3.13 to -2.04, Z = 9.36, P < 0.001), antibiotic prescription rate (OR = 0.23, 95%CI: 0.12 - 0.44, Z = 4.52, P < 0.001), antibiotic costs (WMD = USD-91.72, 95%CI: -109.44 to -74.00, Z = 10.15, P < 0.001) and persistent/relapsed infection rate (OR = 0.70, 95%CI: 0.5 - 0.97, Z = 2.13, P = 0.03). There were no statistical differences in rate of need for intensive care (OR = 0.8, 95%CI: 0.59 - 1.09, Z = 1.41, P = 0.16), in hospital mortality (OR = 1.01, 95%CI: 0.69 - 1.48, Z = 0.07, P = 0.94), length of hospital stay (WMD = -0.27 d, 95%CI: -0.9 - 0.35, Z = 0.86, P = 0.39), and clinical success rate (OR = 1.04, 95%CI: 0.65 - 1.65, Z = 0.16, P = 0.88). The implementation of a procalcitonin-based algorithm may reduce antibiotic exposure in patients with lower respiratory tract infections, but further research is necessary before the wide adoption of this strategy.