Guided therapy can improve antibiotic resistance

Procalcitonin (PCT)-guided therapy to guide antibiotic treatment in patients with acute respiratory infections helped not only reduce the amount of antibiotics given to patients but also reduced the number of deaths and antibiotic-related side effects, according to a new study.

In February 2017, the FDA approved the expanded use of the Vidas Brahms PCT Assay to help healthcare providers determine if antibiotic treatment should be started or stopped in patients with lower respiratory tract infections, such as community-acquired pneumonia, and stopped in patients with sepsis. This is the first test to use PCT, a protein associated with the body’s response to a bacterial infection, as a biomarker to help make antibiotic management decisions in patients with these conditions.

The study, published in the Lancet, is the first to show that using PCT-guided therapy helped not only reduce the amount of antibiotics given to patients but also reduced the number of deaths and antibiotic-related side effects. 

Schuetz

Philipp Schuetz, MD, MPH, Medical University Department, Kantonsspital Aaurau, Aauru, Switzerland, and faculty of medicine, University of Basel, Basel, Switzerland, and colleagues conducted an individual patient-level meta-analysis of data from trials in which patients with respiratory infections were randomly assigned to either a PCT-guided antibiotic treatment group or a control group. The primary end points were 30-day mortality and setting-specific treatment failure, and the secondary end points were antibiotic use, length of stay and antibiotic side effects. The study included 6,708 patients from 26 trials in 12 countries. These trials compared PCT-guided algorithms versus standard care among adult patients with acute respiratory infections.

“The mistreatment of non-infectious or viral respiratory conditions is a leading driver of antimicrobial resistance in the clinical setting, as well as antibiotic side effects,” Schuetz says. “This overuse and misuse causes enormous suffering and unparalleled waste of healthcare dollars.

“The use of this blood infection biomarker holds great promise as a broad tool to counteract antimicrobial resistance due to its ability to assist in the discrimination of viral and bacterial infections and guiding both prescription and duration of antibiotic therapy,” he says. “The study establishes that PCT measurement over time can allow clinicians to individualize therapy for each specific patient compared to fixed doses, which are often imprecise and therefore contribute to the growing problem of resistance.”

According to Schuetz, several individual trials showed positive effects with a reduction of antibiotic exposure in patients with respiratory infections. Yet, he says, there has been ongoing concern about safety of this approach regarding mortality.

“This analysis established both the safety of PCT-guided therapy and a reduction in mortality,” he says.

The study also found that PCT helped to guide physician decision making that resulted in the reduction of antibiotics by two to four days in their patients without any harm to patients, thus disrupting the outdated idea that you have to keep a patient on antibiotics for a specific course, such as eight days, according to Schuetz.

“The reduction of antibiotic use without increasing the risk for adverse patient outcomes is an international priority,” he says. “Over the last decade, procalcitonin has been proposed as an adjunct to clinical judgment and traditional clinical parameters to guide antibiotic prescribing practices in patients with acute respiratory infections.”

Healthcare executives must balance evidence-based best clinical practices with value-based payment models, according to Schuetz.

“The key to achieving these goals-which oftentimes seem contradictory- is rapid and accurate medical testing,” Schuetz says. “From cancer to diabetes to infectious diseases, an immeasurable amount of morbidity and mortality, as well as tremendous financial waste, result from the treatment of patients based on incomplete, erroneous, delayed or absent medical test results.”