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Procalcitonin Guidance to Reduce Antibiotic Treatment of Lower Respiratory Tract Infection in Children and Adolescents (ProPAED): A Randomized Controlled Trial
BACKGROUND: 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. METHODS: Between 01/2009 and 02/2010 we randomized pr...
Autores principales: | , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2013
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3735552/ https://www.ncbi.nlm.nih.gov/pubmed/23936304 http://dx.doi.org/10.1371/journal.pone.0068419 |
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author | 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 |
author_facet | 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 |
author_sort | Baer, Gurli |
collection | PubMed |
description | BACKGROUND: 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. METHODS: 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. RESULTS: 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<0.001). There was no apparent difference in impairment of daily activities between PCT guided and control patients. CONCLUSION: 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. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN17057980 ISRCTN17057980 |
format | Online Article Text |
id | pubmed-3735552 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2013 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-37355522013-08-09 Procalcitonin Guidance to Reduce Antibiotic Treatment of Lower Respiratory Tract Infection in Children and Adolescents (ProPAED): A Randomized Controlled Trial 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 PLoS One Research Article BACKGROUND: 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. METHODS: 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. RESULTS: 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<0.001). There was no apparent difference in impairment of daily activities between PCT guided and control patients. CONCLUSION: 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. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN17057980 ISRCTN17057980 Public Library of Science 2013-08-06 /pmc/articles/PMC3735552/ /pubmed/23936304 http://dx.doi.org/10.1371/journal.pone.0068419 Text en © 2013 Baer et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited. |
spellingShingle | Research Article 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 Procalcitonin Guidance to Reduce Antibiotic Treatment of Lower Respiratory Tract Infection in Children and Adolescents (ProPAED): A Randomized Controlled Trial |
title | Procalcitonin Guidance to Reduce Antibiotic Treatment of Lower Respiratory Tract Infection in Children and Adolescents (ProPAED): A Randomized Controlled Trial |
title_full | Procalcitonin Guidance to Reduce Antibiotic Treatment of Lower Respiratory Tract Infection in Children and Adolescents (ProPAED): A Randomized Controlled Trial |
title_fullStr | Procalcitonin Guidance to Reduce Antibiotic Treatment of Lower Respiratory Tract Infection in Children and Adolescents (ProPAED): A Randomized Controlled Trial |
title_full_unstemmed | Procalcitonin Guidance to Reduce Antibiotic Treatment of Lower Respiratory Tract Infection in Children and Adolescents (ProPAED): A Randomized Controlled Trial |
title_short | Procalcitonin Guidance to Reduce Antibiotic Treatment of Lower Respiratory Tract Infection in Children and Adolescents (ProPAED): A Randomized Controlled Trial |
title_sort | procalcitonin guidance to reduce antibiotic treatment of lower respiratory tract infection in children and adolescents (propaed): a randomized controlled trial |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3735552/ https://www.ncbi.nlm.nih.gov/pubmed/23936304 http://dx.doi.org/10.1371/journal.pone.0068419 |
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