Procalcitonin-Guided Antibiotic Stewardship in Lower Respiratory Tract Infections: A Systematic Review

Abstract

Introduction: Differentiating bacterial from viral lower respiratory tract infections (LRTIs) is challenging, often leading to antibiotic overuse. Procalcitonin (PCT) is a biomarker that can guide decisions to initiate or discontinue antibiotics. This review assesses the impact of PCT-guided therapy.

Methods: A search was conducted for RCTs comparing a PCT-guided antibiotic stewardship protocol to standard care in adult patients with LRTIs (e.g., bronchitis, pneumonia). Primary outcomes were antibiotic exposure duration and clinical outcomes like mortality.

Results: The meta-analysis of 25 RCTs showed that the use of a PCT algorithm significantly reduced the duration of antibiotic exposure and the total antibiotic consumption without increasing the risk of treatment failure, mortality, or length of hospital stay.

Discussion: Implementing a PCT-guided protocol is a safe and effective strategy for antibiotic stewardship. It provides clinicians with objective data to support the decision to withhold or stop antibiotics, thereby reducing resistance pressure and side effects.

Conclusion: Procalcitonin-guided therapy safely reduces antibiotic exposure in patients with lower respiratory tract infections.