Reassessment of a meta-analysis of procalcitonin-guided antibiotic therapy for lower respiratory tract infections

The forest plot shows no advantage of antibiotic intervention on lower respiratory tract infections among the emergency department trials, in which almost all patients had lower respiratory tract infections; whereas, studies done in intensive care units show a stronger and more substantial effect of...

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Bibliographic Details
Published in:The Lancet infectious diseases 2018-02, Vol.18 (2), p.140-140
Main Authors: Keshary, Aarati, Badgett, Robert G
Format: Article
Language:English
Subjects:
Anti-Bacterial Agents
Anti-Infective Agents
Antibiotics
Calcitonin
Carbon dioxide removal
Dose-response effects
Hospitals
Humans
Infections
Infectious diseases
Intensive care
Mortality
Patients
Procalcitonin
Respiratory tract
Respiratory tract diseases
Respiratory tract infection
Respiratory Tract Infections
Studies
Ventilation
Ventilators
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Summary:The forest plot shows no advantage of antibiotic intervention on lower respiratory tract infections among the emergency department trials, in which almost all patients had lower respiratory tract infections; whereas, studies done in intensive care units show a stronger and more substantial effect of this treatment on the infections.1 However, we calculated that the median prevalence of lower respiratory tract infections in intensive care unit trials was 46% (IQR 35-64), with some trials having less than 5% of patients with lower respiratory tract infections.1 Second, no dose-response effect of circulating procalcitonin testing on mortality reduction exists. [...]optimisation of care might be inconsistent in the control groups. 5 AH Morris, CJ Wallace, RL Menlove, Randomized clinical trial of pressure-controlled inverse ratio ventilation and extracorporeal CO2 removal for adult respiratory distress syndrome, Am J Respir Crit Care Med, Vol. 149, 1994, 295-305 6 TD East, LK Heermann, RL Bradshaw, Efficacy of computerized decision support for mechanical ventilation: results of a prospective multi-center randomized trial, Proc AMIA Symp, 1999, 251-255 7 B Djulbegovic, M Lacevic, A Cantor, The uncertainty principle and industry-sponsored research, Lancet, Vol. 356, 2000, 635-638
ISSN:1473-3099
1474-4457
DOI:10.1016/S1473-3099(18)30014-8