Effect of procalcitonin-based guidelines vs standard guidelines on antibiotic use in lower respiratory tract infections: the ProHOSP randomized controlled trial

Results The rate of overall adverse outcomes was similar in the PCT and control groups (15.4% [n=103] vs 18.9% [n=130]; difference, �3.5%; 95% CI, �7.6% to 0.4%). The mean duration of antibiotics exposure in the PCT vs control groups was lower in all patients (5.7 vs 8.7 days; relative change, �34.8%; 95% CI, �40.3% to �28.7%) and in the subgroups of patients with community-acquired pneumonia (n=925, 7.2 vs 10.7 days; �32.4%; 95% CI, �37.6% to �26.9%), exacerbation of chronic obstructive pulmonary disease (n=228, 2.5 vs 5.1 days; �50.4%; 95% CI, �64.0% to �34.0%), and acute bronchitis (n=151, 1.0 vs 2.8 days; �65.0%; 95% CI, �84.7% to �37.5%). Antibiotic-associated adverse effects were less frequent in the PCT group (19.8% [n=133] vs 28.1% [n=193]; difference, �8.2%; 95% CI, �12.7% to �3.7%). Conclusion In patients with LRTIs, a strategy of PCT guidance compared with standard guidelines resulted in similar rates of adverse outcomes, as well as lower rates of antibiotic exposure and antibiotic-associated adverse effects. Trial Registration isrctn.org Identifier: ISRCTN95122877