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Procalcitonin & Antibiotic Decisions

The advent of antibiotic therapy has led to dramatic reductions in mortality and morbidity due to bacterial infections and sepsis. The overuse of antibiotics to treat infections, however, may expose patients to adverse events resulting from use of these agents and by increasing the risk of developing bacterial resistance. To fight the emergence of bacterial resistance to antimicrobial agents, more effective efforts are needed to reduce the inappropriate or unnecessarily prolonged use of antibiotics. A novel approach for determining the need and optimal duration of antibiotic therapy is to use biomarkers of bacterial infections (see also, Procalcitonin: A Biomarker for Early Sepsis Intervention). One such biomarker is procalcitonin (PCT), which has been shown to become up-regulated during bacterial infections. It also appears to mirror the extent and severity of infections. Measuring PCT levels may help physicians more rationally decide on prescriptions and duration of antibiotic therapy in patients with infections. Previous studies have suggested that using clinical algorithms based on PCT levels results in less antibiotic use without negatively affecting clinical outcomes. However, various trials using such algorithms have been conducted largely in European healthcare settings. New Data from Procalcitonin Algorithms In the August 8, 2011 Archives of Internal Medicine, my colleagues and I performed a systematic review of 14 randomized controlled trials that investigated PCT algorithms for antibiotic treatment decisions in adults with respiratory tract infections and sepsis from primary care, ED, and ICU settings. The aim was to summarize the evidence for using PCT measurements and to propose clinical algorithms for use in future trials in the United States. Our analysis revealed no significant differences in mortality...

Procalcitonin: A Biomarker for Early Sepsis Intervention

Sepsis is a potentially fatal condition that strikes an estimated 750,000 people each year in the United States. Defined as the body’s reaction to infection (whether bacterial, viral, fungal, or parasitic), sepsis is the most common underlying cause of mortality in non-coronary ICUs. It can rapidly lead to systemic inflammatory reactions and, eventually, organ dysfunction or failure. People who are at greatest risk of developing sepsis include patients who are very young or very old, those with compromised immune systems, those who are hospitalized and are very sick, and individuals with invasive devices (eg, urinary catheters or breathing tubes). Early recognition of sepsis, specific clinical interventions, and timely initiation of appropriate therapy are critical for helping patients survive this potentially devastating condition. Unfortunately, sepsis can be difficult to distinguish from other, non-infectious conditions in critically ill patients, especially for those with clinical signs of acute inflammation and negative microbiological results. The condition can be challenging to manage in the early phases of the disease because it may be difficult to decide on the appropriate therapeutic measures for each individual patient. Oftentimes, by the time an accurate diagnosis is made, patients may have progressed to the final stages of the disease. The need for more effective strategies to help intervene in and manage sepsis is urgent. Procalcitonin to Diagnose & Monitor Sepsis A novel biomarker called procalcitonin (PCT) is now being recognized as a useful tool in the diagnostic process for sepsis. PCT can contribute to the risk assessment and optimization of patient management and clinical decisions. It is the prohormone of calcitonin (CT). CT is secreted by the C-cells...
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