J Pediatr Infect Dis 2018; 13(03): 202-209
DOI: 10.1055/s-0038-1657776
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Procalcitonin-Guided Therapy for Reduction of Antibiotic Use in Patients with Bronchiolitis

Sirin Guven
1   Department of Pediatrics, University of Health Sciences, Umraniye Training and Research Hospital, İstanbul, Turkey
,
Duygu Bayoglu
1   Department of Pediatrics, University of Health Sciences, Umraniye Training and Research Hospital, İstanbul, Turkey
,
Pinar Eker
2   Department of Biochemistry, University of Health Sciences, Umraniye Training and Research Hospital, İstanbul, Turkey
› Author Affiliations
Further Information

Publication History

16 October 2017

27 April 2018

Publication Date:
02 June 2018 (online)

Abstract

Objective Procalcitonin (PCT)-guided treatment could reduce antibiotic use in viral lower respiratory tract infections. We evaluated the impact of PCT-guided treatment on antibiotic use in patients hospitalized with bronchiolitis.

Study Design A total of 100 patients aged 1 to 24 months old who were hospitalized with bronchiolitis were included in the study. Patients were randomized into two groups: PCT-guided group received an antibiotic treatment based on PCT levels and control group received an antibiotic treatment according to the physician decision.

Results Antibiotic use on first day in the PCT-guided group (12%) was found to be statistically significantly lower than in the control group (80%) (p = 0.001; p < 0.05; relative risk [RR]: 29.33; 95% confidence interval [CI]: 9.77–88.03). On the third day, antibiotic use was statistically significantly lower in the PCT-guided group (16%) than in the control group (40%) (p = 0.014; p < 0.05; RR: 3.5; 95% CI: 1.36–9).

Conclusion We suggested that PCT guidance will have important contributions to reduce antibiotic use in children with bronchiolitis. Particularly in countries with higher antibiotic prescription rates, this strategy may have implication for reducing the development of antibiotic resistance and side effects due to disturbance of microbiota.

 
  • References

  • 1 Ralston SL, Lieberthal AS, Meissner HC. , et al; American Academy of Pediatrics. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics 2014; 134 (05) e1474-e1502
  • 2 Parikh K, Hall M, Teach SJ. Bronchiolitis management before and after the AAP guidelines. Pediatrics 2014; 133 (01) e1-e7
  • 3 Pelletier AJ, Mansbach JM, Camargo Jr CA. Direct medical costs of bronchiolitis hospitalizations in the United States. Pediatrics 2006; 118 (06) 2418-2423
  • 4 Lange K, Buerger M, Stallmach A, Bruns T. Effects of antibiotics on gut microbiota. Dig Dis 2016; 34 (03) 260-268
  • 5 Francino MP. Antibiotics and the human gut microbiome: dysbioses and accumulation of resistances. Front Microbiol 2016; 6: 1543
  • 6 Simon L, Gauvin F, Amre DK, Saint-Louis P, Lacroix J. Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clin Infect Dis 2004; 39: 206-217 . A published erratum appears in Clin Infect Dis 2005;40:1386–1388
  • 7 Christ-Crain M, Jaccard-Stolz D, Bingisser R. , et al. Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections: cluster-randomised, single-blinded intervention trial. Lancet 2004; 363 (9409): 600-607
  • 8 Schuetz P, Albrich W, Christ-Crain M, Chastre J, Mueller B. Procalcitonin for guidance of antibiotic therapy. Expert Rev Anti Infect Ther 2010; 8 (05) 575-587
  • 9 Schuetz P, Müller B, Christ-Crain M. , et al. Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections. Evid Based Child Health 2013; 8 (04) 1297-1371
  • 10 Ramos Fernández JM, Cordón Martínez A, Galindo Zavala R, Urda Cardona A. Validation of an acute bronchiolitis severity scale [Article in Spanish]. An Pediatr (Barc) 2014; 81 (01) 3-8
  • 11 van der Meer V, Neven AK, van den Broek PJ, Assendelft WJ. Diagnostic value of C reactive protein in infections of the lower respiratory tract: systematic review. BMJ 2005; 331 (7507): 26
  • 12 Whicher J, Bienvenu J, Monneret G. Procalcitonin as an acute phase marker. Ann Clin Biochem 2001; 38 (Pt 5): 483-493
  • 13 Melendi GA, Laham FR, Monsalvo AC. , et al. Cytokine profiles in the respiratory tract during primary infection with human metapneumovirus, respiratory syncytial virus, or influenza virus in infants. Pediatrics 2007; 120 (02) e410-e415
  • 14 Simon L, Gauvin F, Amre DK, Saint-Louis P, Lacroix J. Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clin Infect Dis 2004; 39 (02) 206-217
  • 15 Christ-Crain M, Müller B. Procalcitonin in bacterial infections–hype, hope, more or less?. Swiss Med Wkly 2005; 135 (31-32): 451-460
  • 16 Rey C, Los Arcos M, Concha A. , et al. Procalcitonin and C-reactive protein as markers of systemic inflammatory response syndrome severity in critically ill children. Intensive Care Med 2007; 33 (03) 477-484
  • 17 de Jong E, van Oers JA, Beishuizen A. , et al. Efficacy and safety of procalcitonin guidance in reducing the duration of antibiotic treatment in critically ill patients: a randomised, controlled, open-label trial. Lancet Infect Dis 2016; 16 (07) 819-827
  • 18 Briel M, Schuetz P, Mueller B. , et al. Procalcitonin-guided antibiotic use vs a standard approach for acute respiratory tract infections in primary care. Arch Intern Med 2008; 168 (18) 2000-2007 , discussion 2007–2008
  • 19 Schuetz P, Christ-Crain M, Thomann R. , et al; ProHOSP Study Group. Effect of procalcitonin-based guidelines vs standard guidelines on antibiotic use in lower respiratory tract infections: the ProHOSP randomized controlled trial. JAMA 2009; 302 (10) 1059-1066
  • 20 Toikka P, Irjala K, Juvén T. , et al. Serum procalcitonin, C-reactive protein and interleukin-6 for distinguishing bacterial and viral pneumonia in children. Pediatr Infect Dis J 2000; 19 (07) 598-602
  • 21 Moulin F, Raymond J, Lorrot M. , et al. Procalcitonin in children admitted to hospital with community acquired pneumonia. Arch Dis Child 2001; 84 (04) 332-336
  • 22 Nascimento-Carvalho CM, Cardoso MR, Barral A. , et al. Procalcitonin is useful in identifying bacteraemia among children with pneumonia. Scand J Infect Dis 2010; 42 (09) 644-649
  • 23 Christ-Crain M, Müller B. Biomarkers in respiratory tract infections: diagnostic guides to antibiotic prescription, prognostic markers and mediators. Eur Respir J 2007; 30 (03) 556-573
  • 24 Kristoffersen KB, Søgaard OS, Wejse C. , et al. Antibiotic treatment interruption of suspected lower respiratory tract infections based on a single procalcitonin measurement at hospital admission--a randomized trial. Clin Microbiol Infect 2009; 15 (05) 481-487
  • 25 Schuetz P, Briel M, Christ-Crain M. , et al. Procalcitonin to guide initiation and duration of antibiotic treatment in acute respiratory infections: an individual patient data meta-analysis. Clin Infect Dis 2012; 55 (05) 651-662
  • 26 Schuetz P, Wirz Y, Sager R. , et al. Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections. Cochrane Database Syst Rev 2017; 10: CD007498
  • 27 Schützle H, Forster J, Superti-Furga A, Berner R. Is serum procalcitonin a reliable diagnostic marker in children with acute respiratory tract infections? A retrospective analysis. Eur J Pediatr 2009; 168 (09) 1117-1124
  • 28 Esposito S, Tagliabue C, Picciolli I. , et al. Procalcitonin measurements for guiding antibiotic treatment in pediatric pneumonia. Respir Med 2011; 105 (12) 1939-1945
  • 29 Baer G, Baumann P, Buettcher M. , et al. Procalcitonin guidance to reduce antibiotic treatment of lower respiratory tract infection in children and adolescents (ProPAED): a randomized controlled trial. PLoS One 2013; 8 (08) e68419
  • 30 Ceyhan M, Yildirim I, Ecevit C. , et al. Inappropriate antimicrobial use in Turkish pediatric hospitals: a multicenter point prevalence survey. Int J Infect Dis 2010; 14 (01) e55-e61
  • 31 Leblebicioglu H, Canbaz S, Peksen Y, Gunaydin M. Physicians' antibiotic prescribing habits for upper respiratory tract infections in Turkey. J Chemother 2002; 14 (02) 181-184