Guideline for Antibiotic Use in Adults with Community-acquired Pneumonia

Lee, Mi Suk; Oh, Jee Youn; Kang, Cheol-In; Kim, Eu Suk; Park, Sunghoon; Rhee, Chin Kook; Jung, Ji Ye; Jo, Kyung-Wook; Heo, Eun Young; Park, Dong-Ah; Suh, Gee Young; Kiem, Sungmin

Numerous randomized controlled clinical studies have been conducted to determine whether or not procalcitonin can be used as criteria for beginning or ceasing antibiotic use. According to a meta-analysis that analysed 4,221 patients 14 different acute respiratory infections, using procalcitonin as the criteria for antibiotic use did not lead to significant differences in the risk of treatment failure and mortality rate compared with when existing treatment guidelines were used, but significantly reduced the number of days of antibiotic use [210] . When the meta-analysis analysed patients with community-acquired pneumonia separately, there was no significant difference in the mortality rate between the procalcitonin and control groups (9.2% and 10.8%, respectively; adjusted odds ratio (OR) 0.89 (95% CI 0.64-1.23). However, the rate of treatment failure was lower in the procalcitonin group compared with the existing treatment group (19.0% and 23.4%, respectively; adjusted OR 0.77 [95% CI 0.62-0.96, P <0.05]), and the median number of days of antibiotic use decreased by 3.9 days from 10 to 6 days (P <0.01) [211] . A prospective multi-institutional randomized controlled clinical study has recently published its findings regarding the use of the procalcitonin test as the criteria for cessation of antibiotic use in patients who are administered antibiotics within 24 hours after ICU admission due to an infection [212] . Of the 1,575 patients included in this study, 792 (50.3%) had community-acquired pneumonia. In the procalcitonin group, cessation of antibiotic use was recommended if the procalcitonin level has decreased by over 80% relative to the level at the time of admission, or if the level is below 0.5 μg/L. Consistent with previous studies, the doses of antibiotics used and the duration of antibiotic use significantly decreased in the procalcitonin group compared with the control group. The mortality rate at 28 days decreased by 5.4% (P = 0.0122), and the one-year mortality rate decreased by 6.1% (P = 0.0158) in the procalcitonin group compared with the control group. However, most of studies have been published in Europe, and the patient groups included in the studies are heterogeneous in terms of diseases. In addition, the ratio of patients in the procalcitonin group varied depending on the research https://doi.org/10.3947/ic.2018.50.2.160 • Infect Chemother 2018;50(2): www.icjournal.org 185 algorithm (47-81%). Further studies are needed to investigate the cost-effectiveness of the procalcitonin test in reducing the cost of antibiotic prescriptions, and it is yet too early to recommend antibiotic treatment according to procalcitonin test results in an actual clinical practice guideline.