Procalcitonin to Guide Duration of Antimicrobial Therapy- Breakthrough?

Source: Infectious Diseases News

Serum levels of procalcitonin (PCT), the precursor to calcitonin, are elevated in certain cancers neoplasms and in inflammatory conditions, including bacterial infections and sepsis. PCT elevation occurs within 2–4 hours after onset of the inflammatory disorder, often peaks in the second day, and falls rapidly during clinical recovery. PCT elevation may correlate with prognosis.


Can the use of serum procalcitonin levels safely reduce antimicrobial use in intensive care unit (ICU) patients? A systematic literature review  study published in Clinical Infectious Diseases addressed this question.


The review identified 6 published randomized controlled trials comparing PCT-guided antimicrobial therapy to usual care in ICU patients. Procalcitonin guidance was associated with significantly reduced antimicrobial exposure (effect sizes, 19.5%–38%) in all 5 studies assessing its impact on treatment duration.  Length of ICU stay was significantly decreased in 2 studies but was unchanged in the others. No significant difference infection relapse or mortality was observed. 


Procalcitonin guidance of antimicrobial duration appears to decrease antimicrobial use in the ICU patients. 


Could this be the next great breakthrough for antibiotic stewardship programs as they oversee and guide antimicrobial usage in attempt to maximize benefit and minimize harm and antimicrobial resistance?