Procalcitonin Can Help Reduce Antibiotic Exposure
A call to action for managing antibiotic prescription and administration
There’s no denying the value of using antibiotics to fight bacterial infections. These powerful drugs are generally safe, but when used inappropriately antibiotics can be harmful and sometimes deadly.
What does inappropriate antibiotic use look like?
A healthcare provider prescribes antibiotics in the absence of a bacterial infection or when an alternative treatment course may be more appropriate.
A patient does not take their antibiotics as prescribed or is exposed to prolonged treatment even after elimination of an infection.
Both scenarios can lead to a range of not-so-pleasant side effects of antibiotics, such as:1
- Renal or liver toxicity
- From mild skin rash to allergic shock
- Soft stools
- From short-term to life-threatening diarrhea by Clostridioides difficile
- Upset stomach
- Nausea
- Loss of appetite
- Yeast infections
Antibiotics are the leading cause of emergency department visits for adverse drug events in children and adolescents.1
Inappropriate use of antibiotics can be dangerous
Using antibiotics inappropriately—for example, in the case of viral infections—may do more harm than good. Indeed, antibiotics cause 1 out of 5 emergency department visits for adverse drug events and are the most common cause of emergency department visits for adverse drug events in children under 18 years of age. Taking unnecessary antibiotics also increases the risk of getting an antibiotic-resistant infection later. In addition, studies demonstrate an association between inappropriate antibiotic use and increased mortality.2-7
Antibiotics can spur the growth of Clostridioides difficile and other harmful bacteria
Antibiotics kill the healthy bacteria in the gut, allowing more harmful bacteria, such as Clostridioides difficile (C. diff), to grow in its place. Infections caused by C. diff may lead to serious, possibly life-threatening diarrhea. People over the age of 65, as well as those who are hospitalized for a prolonged time or have had recent antibiotic exposure, are at high risk for C. diff. 8
According to the CDC, most cases of C. diff infection (CDI) occur while taking antibiotics or not long after finishing antibiotics.9 Studies have shown that long term use of antibiotics and cumulative exposure are significant risk factors for CDI.10,11 Antimicrobial stewardship programs that focus on the overall reduction of total dose as well as number and days of antibiotic exposure and the substitution of high-risk antibiotic classes for lower-risk alternatives may reduce the incidence of hospital-acquired CDI.11
The rise of antibiotic stewardship programs
Increasing numbers of hospitals are implementing antibiotic stewardship programs to encourage appropriate antibiotic prescribing, with the goal of preventing antibiotic resistance. One tool these programs rely on is procalcitonin (PCT), a sensitive, specific and timely biomarker that may already be present within existing healthcare systems.
Using procalcitonin to reduce antibiotic exposure
Whether in the emergency department or inpatient hospital setting, PCT testing can help clinicians provide tailored antibiotic therapy to avoid the inappropriate overuse of antibiotics—an essential component of antibiotic stewardship programs.
Here’s a look at some ways PCT testing can reduce antibiotic exposure and improve outcomes:
- As much as 75% of all antibiotic doses are prescribed for acute respiratory-tract infections, despite their mainly viral cause.4 PCT- aided antibiotic therapy in these patients allows a reduction in antibiotic exposure without any adverse impact on outcome.6
- In patients with lower respiratory tract infections, multiple randomized-controlled studies comparing standard-of-care (control group) to a procalcitonin-aided group show a reduction in antibiotic exposure in the PCT-group between 34.5-72.2% in adults and 26.8-51.0% in children.4-6,9,10
- Ensuring that septic patients receive the correct antibiotic treatment is still a challenge for physicians. The incorrect application of antimicrobial therapies results in an increased risk of opportunistic infections, resistance to multiple antimicrobial agents, and toxic side effects, which can lead to increased mortality and also higher costs. PCT-guided antibiotic therapy can help reduce total antibiotic usage and decrease the duration of antibiotic therapy. 11,12
For example, studies show a reduction in the antibiotic exposure rate of up to 50% in the procalcitonin-aided group as compared to the standard-of-care (control) group.7
Reducing levels of antibiotic use has, in turn, led to improved short- and long-term survival rates. 4,7 In short, procalcitonin can help save lives.
Customizing antibiotic treatment with PCT
With the right biomarker testing in place, hospitals can bolster their antibiotic stewardship programs and reduce unnecessary antibiotic exposure. Procalcitonin gives clinicians the information they need to determine whether to prescribe or discontinue antibiotic therapy. However, testing for PCT alone isn’t enough. It’s also necessary to understand what the results mean, and how PCT can shape a successful approach to treatment.
Want to learn how to interpret PCT results?
Explore how PCT may aid in therapeutic decision making in different clinical settings:
Learn more about implementing optimized procalcitonin testing in your hospital.
- Centers for Disease Control and Prevention. Adverse drug event monitoring [Internet]. Atlanta (GA). [updated 2017 Aug 17; cited 2020 Dec 10] Available here.
- de Jong E, van Oers J, Beishuizen A, Vos P, Vermeijden W, Haas L, 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 Jul 1;16(7):819-27.
- Bouadma L, Luyt CE, Tubach F, Cracco C, Alvarez A, Schwebel C, et al. Use of procalcitonin to reduce patients' exposure to antibiotics in intensive care units (PRORATA trial): A multicentre randomised controlled trial. Lancet Infect Dis. 2010 Feb 6;375(9713):463-74.
- Christ-Crain M, Jaccard-Stolz D, Bingisser R, Genacay MM, Huber PR, Tamm M, et al. Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections: Cluster-randomised, single-blinded intervention trial. Lancet Infect Dis. 2004 Feb 21;363(9409):600-7.
- Christ-Crain M, Stolz D, Bingisser R, Müller CH, Miedinger D, Huber PR, et al. Procalcitonin guidance of antibiotic therapy in community-acquired pneumonia: A randomized trial. Am J Respir Crit Care Med. 2006 Jul 1;174(1):84-93.
- Schuetz P, Christ-Crain M, Thomann R. Effect of procalcitonin-based guidelines vs standard guidelines on antibiotic use in lower respiratory tract infections: The proHOSP randomized controlled trial. JAMA. 2009 Sep 9;302(10):1059-66.
- Kyriazopoulou E, Liaskou-Antoniou L, Adamis G, Panagaki A, Melachroinopoulos N, Drakou E, et al. Procalcitonin to reduce long-term infection-associated adverse events in sepsis. a randomized trial. Am J Respir Crit Care Med. 2021 Jan 15;203(2):202-10.1201OC
- Gerding DN, Lessa FC. The epidemiology of Clostridium difficile infection inside and outside health care institutions. Infect Dis Clin North Am. 2015; 29: 37-50.
- https://www.cdc.gov/cdiff/pdf/Cdiff-progression-H.pdf
- Zhang, Shanshan et al. “Cost of hospital management of Clostridium difficile infection in United States-a meta-analysis and modelling study.” BMC infectious diseases vol. 16,1 447. 25 Aug. 2016, doi:10.1186/s12879-016-1786-6
- Stevens V, Dumyati G, Fine LS, Fisher SG, van Wijngaarden E. Cumulative antibiotic exposures over time and the risk of Clostridium difficile infection. Clin Infect Dis. 2011 Jul 1;53(1):42-8. doi: 10.1093/cid/cir301. PMID: 21653301.
- Long W, Li LJ, Huang GZ, Zhang XM, Zhang YC, Tang JG, et al. Procalcitonin guidance for reduction of antibiotic use in patients hospitalized with severe acute exacerbations of asthma: a randomized controlled study with 12-month follow-up. Crit Care Med. 2014 Oct;18(5):1-9.
- Briel M, Schuetz P, Mueller B, Young J, Schild U, Nusbaumer C, et al. Procalcitonin-guided antibiotic use vs a standard approach for acute respiratory tract infections in primary care. Arch Intern Med. 2008 Oct 13;168(18):2000-7.
- Zilahi G, McMahon MA, Povoa P, Martin-Loeches I. Duration of antibiotic therapy in the intensive care unit. J Thorac Dis . 2016 Dec;8(12):3774.
- Jee Y, Carlson J, Rafai E, Musonda K, Huong TT, Daza P, et al. Antimicrobial resistance: A threat to global health. The Lancet. Infectious diseases. 2018 Sep 1;18(9):939-40.
- Hochreiter M, Köhler T, Schweiger AM, Keck FS, Bein B, von Spiegel T, et al. Procalcitonin to guide duration of antibiotic therapy in intensive care patients: A randomized prospective controlled trial. Crit Care Med. 2009 Jun;13(3):1-7
- Stocker M, Van Herk W, El Helou S, Dutta S, Fontana MS, Schuerman FA, et al. Procalcitonin-guided decision making for duration of antibiotic therapy in neonates with suspected early-onset sepsis: A multicentre, randomised controlled trial (NeoPIns). Lancet Inf Dis. 2017 Aug 26;390(10097):871-81.
- Stolz D, Christ-Crain M, Bingisser R, Leuppi J, Miedinger D, Muller C, Huber P, Muller B and Tamm M Antibiotic Treatment of Exacerbations of COPD: A Randomized, Controlled Trial Comparing Procalcitonin-Guidance With Standard Therapy Chest 2007;131 (1),Jan: 9-19. DOI: 10.1378/chest.06-1500
- Esposito et al., Respir Med 2011; 105: 1939-1945
