By Reuters Staff
NEW YORK (Reuters Health) - Using a procalcitonin assay does not reduce antibiotic use among patients with a suspected lower respiratory tract infection, doctors behind a large randomized study done at 14 U.S. hospitals have concluded.
Compared to patients whose doctors recommended antibiotics without assistance from the test, there was no significant difference in the number of antibiotic days or the proportion of patients who had an adverse outcome.
The doctors behind the ProACT study had expected the procalcitonin test to make a significant difference in both measures.
The findings were reported May 20 at the American Thoracic Society Conference in San Diego and online by the New England Journal of Medicine.
Some doctors have been using procalcitonin because levels of the peptide typically rise with a bacterial infection, making it easier to differentiate between that and a viral infection in the lower respiratory tract.
The U.S. Food and Drug Administration approved the test in February 2017 after studies suggested that procalcitonin was an effective bellwether of infection severity. Nonetheless, the effectiveness of the test has remained in dispute.
None of the hospitals in the study routinely used procalcitonin before the trial began, and staffs were trained in how to use the test. All cases of nonadherence to the guidelines were reviewed in instances where the test was part of the patient's protocol. All patients had blood drawn for the test but the results in the usual-care group were withheld. The doctors adhered to the guidelines in 64.8% of the 1,656 patients.
Mean antibiotic exposure was 4.2 days in the procalcitonin group and 4.3 days in the usual care group (P=0.87).
And while 11.7% in the procalcitonin group had a safety outcome event such as endotracheal intubation, death, or hospital readmission, the rate was 13.1% with usual care. Hospital readmission was the most common problem, with rates of 7.6% with the test and 8.5% with usual care.
In a subgroup analysis, the test did make a difference in antibiotic use in patients with acute bronchitis. The prescription rate was 17.3% with the test and 32.1% without.
The research team, led by David Huang of the University of Pittsburgh, noted that the team "did not directly address whether antibiotics can be safely withheld on the basis of a low procalcitonin level alone but rather tested the effect of a deployment strategy to promote the recommended us of the assay in clinical practice."
N Engl J Med 2018
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