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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...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2013
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
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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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