Procalcitonin guidance to reduce antibiotic treatment of lower respiratory tract infection in children and adolescents (ProPAED): a randomized controlled trial

Antibiotics are overused in children and adolescents with lower respiratory tract infection (LRTI). Serum-procalcitonin (PCT) can be used to guide treatment when bacterial infection is suspected. Its role in pediatric LRTI is unclear. Between 01/2009 and 02/2010 we randomized previously healthy pati...

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Published in:PloS one 2013-08, Vol.8 (8), p.e68419-e68419
Main Authors: Baer, Gurli, Baumann, Philipp, Buettcher, Michael, Heininger, Ulrich, Berthet, Gerald, Schäfer, Juliane, Bucher, Heiner C, Trachsel, Daniel, Schneider, Jacques, Gambon, Muriel, Reppucci, Diana, Bonhoeffer, Jessica M, Stähelin-Massik, Jody, Schuetz, Philipp, Mueller, Beat, Szinnai, Gabor, Schaad, Urs B, Bonhoeffer, Jan
Format: Article
Language:English
Subjects:
Adolescent
Adolescents
Age
Algorithms
Analysis
Anti-Bacterial Agents - therapeutic use
Antibiotics
Antimicrobial agents
Bacteria
Bacterial infections
Biology
Biomarkers - blood
Calcitonin - blood
Calcitonin Gene-Related Peptide
Care and treatment
Child
Children
Children & youth
Children's hospitals
Clinical trials
Emergency medical services
Epidemiology
Exposure
Humans
Impairment
Infections
Internal medicine
Medicine
Mortality
Motivation
Patients
Pediatrics
Pneumonia
Practice guidelines (Medicine)
Prescription writing
Primary care
Procalcitonin
Protein Precursors - blood
Randomization
Respiratory tract
Respiratory tract diseases
Respiratory tract infection
Respiratory Tract Infections - blood
Respiratory Tract Infections - drug therapy
Teenagers
Treatment Outcome
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cited_by cdi_FETCH-LOGICAL-c593t-cfaa85824dacd2be3dbf912e02a69f2c9bbc575fef2b7beaada479af251090d83
cites cdi_FETCH-LOGICAL-c593t-cfaa85824dacd2be3dbf912e02a69f2c9bbc575fef2b7beaada479af251090d83
container_end_page e68419
container_issue 8
container_start_page e68419
container_title PloS one
container_volume 8
creator Baer, Gurli
Baumann, Philipp
Buettcher, Michael
Heininger, Ulrich
Berthet, Gerald
Schäfer, Juliane
Bucher, Heiner C
Trachsel, Daniel
Schneider, Jacques
Gambon, Muriel
Reppucci, Diana
Bonhoeffer, Jessica M
Stähelin-Massik, Jody
Schuetz, Philipp
Mueller, Beat
Szinnai, Gabor
Schaad, Urs B
Bonhoeffer, Jan
description Antibiotics are overused in children and adolescents with lower respiratory tract infection (LRTI). Serum-procalcitonin (PCT) can be used to guide treatment when bacterial infection is suspected. Its role in pediatric LRTI is unclear. Between 01/2009 and 02/2010 we randomized previously healthy patients 1 month to 18 years old presenting with LRTI to the emergency departments of two pediatric hospitals in Switzerland to receive antibiotics either according to a PCT guidance algorithm established for adult LRTI or standard care clinical guidelines. In intention-to-treat analyses, antibiotic prescribing rate, duration of antibiotic treatment, and number of days with impairment of daily activities within 14 days of randomization were compared between the two groups. In total 337 children, mean age 3.8 years (range 0.1-18), were included. Antibiotic prescribing rates were not significantly different in PCT guided patients compared to controls (OR 1.26; 95% CI 0.81, 1.95). Mean duration of antibiotic exposure was reduced from 6.3 to 4.5 days under PCT guidance (-1.8 days; 95% CI -3.1, -0.5; P = 0.039) for all LRTI and from 9.1 to 5.7 days for pneumonia (-3.4 days 95% CI -4.9, -1.7; P
doi_str_mv 10.1371/journal.pone.0068419
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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Baer, Gurli</au><au>Baumann, Philipp</au><au>Buettcher, Michael</au><au>Heininger, Ulrich</au><au>Berthet, Gerald</au><au>Schäfer, Juliane</au><au>Bucher, Heiner C</au><au>Trachsel, Daniel</au><au>Schneider, Jacques</au><au>Gambon, Muriel</au><au>Reppucci, Diana</au><au>Bonhoeffer, Jessica M</au><au>Stähelin-Massik, Jody</au><au>Schuetz, Philipp</au><au>Mueller, Beat</au><au>Szinnai, Gabor</au><au>Schaad, Urs B</au><au>Bonhoeffer, Jan</au><au>von Seidlein, Lorenz</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Procalcitonin guidance to reduce antibiotic treatment of lower respiratory tract infection in children and adolescents (ProPAED): a randomized controlled trial</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2013-08-06</date><risdate>2013</risdate><volume>8</volume><issue>8</issue><spage>e68419</spage><epage>e68419</epage><pages>e68419-e68419</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Antibiotics are overused in children and adolescents with lower respiratory tract infection (LRTI). Serum-procalcitonin (PCT) can be used to guide treatment when bacterial infection is suspected. Its role in pediatric LRTI is unclear. Between 01/2009 and 02/2010 we randomized previously healthy patients 1 month to 18 years old presenting with LRTI to the emergency departments of two pediatric hospitals in Switzerland to receive antibiotics either according to a PCT guidance algorithm established for adult LRTI or standard care clinical guidelines. In intention-to-treat analyses, antibiotic prescribing rate, duration of antibiotic treatment, and number of days with impairment of daily activities within 14 days of randomization were compared between the two groups. In total 337 children, mean age 3.8 years (range 0.1-18), were included. Antibiotic prescribing rates were not significantly different in PCT guided patients compared to controls (OR 1.26; 95% CI 0.81, 1.95). Mean duration of antibiotic exposure was reduced from 6.3 to 4.5 days under PCT guidance (-1.8 days; 95% CI -3.1, -0.5; P = 0.039) for all LRTI and from 9.1 to 5.7 days for pneumonia (-3.4 days 95% CI -4.9, -1.7; P&lt;0.001). There was no apparent difference in impairment of daily activities between PCT guided and control patients. PCT guidance reduced antibiotic exposure by reducing the duration of antibiotic treatment, while not affecting the antibiotic prescribing rate. The latter may be explained by the low baseline prescribing rate in Switzerland for pediatric LRTI and the choice of an inappropriately low PCT cut-off level for this population. Controlled-Trials.com ISRCTN17057980 http://www.controlled-trials.com/ISRCTN17057980.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>23936304</pmid><doi>10.1371/journal.pone.0068419</doi><oa>free_for_read</oa></addata></record>
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identifier ISSN: 1932-6203
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1932-6203
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subjects Adolescent
Adolescents
Age
Algorithms
Analysis
Anti-Bacterial Agents - therapeutic use
Antibiotics
Antimicrobial agents
Bacteria
Bacterial infections
Biology
Biomarkers - blood
Calcitonin - blood
Calcitonin Gene-Related Peptide
Care and treatment
Child
Children
Children & youth
Children's hospitals
Clinical trials
Emergency medical services
Epidemiology
Exposure
Humans
Impairment
Infections
Internal medicine
Medicine
Mortality
Motivation
Patients
Pediatrics
Pneumonia
Practice guidelines (Medicine)
Prescription writing
Primary care
Procalcitonin
Protein Precursors - blood
Randomization
Respiratory tract
Respiratory tract diseases
Respiratory tract infection
Respiratory Tract Infections - blood
Respiratory Tract Infections - drug therapy
Teenagers
Treatment Outcome
title Procalcitonin guidance to reduce antibiotic treatment of lower respiratory tract infection in children and adolescents (ProPAED): a randomized controlled trial
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