Procalcitonin measurements for guiding antibiotic treatment in pediatric pneumonia
Procalcitonin measurements for guiding antibiotic treatment in pediatric pneumonia
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DOI：
10.1016/j.rmed.2011.09.003
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发表时间：
2011-12-01
影响因子：
4.3
通讯作者：
Principi, Nicola
中科院分区：
文献类型：
--
作者：
Esposito, Susanna;Tagliabue, Claudia;Principi, Nicola
为了评价使用基于降钙素原（PCT）临界值的算法作为指导抗生素治疗的方法，将319例患有无并发症社区获得性肺炎（CAP）的住院儿童按1：1的比例随机分配，根据算法或标准指南进行治疗。PCT组的儿童如果入院时PCT水平为0.25 ng/mL，则不接受抗生素治疗。最终分析基于PCT组155例患者和对照组155例患者。与对照组相比，PCT组接受的抗生素处方明显较少（85.8% vs 100%; p < 0.05），暴露于抗生素的时间较短（5.37 vs 10.96天; p < 0.05），并且经历了较少的抗生素相关不良事件（3.9% vs 25.2%; p < 0.05），无论CAP的严重程度如何。在入组后的一个月内，两组之间在呼吸道症状复发和新抗生素处方方面没有显著差异。这是第一项使用PCT临界值指导儿科CAP抗生素治疗的前瞻性研究，结果表明，这种方法可以显着减少无并发症儿童的抗生素使用和抗生素相关不良事件。然而，由于该研究主要包括轻度至中度CAP儿童，并且使用基于算法的方法的风险在相关数量的严重病例中未得到验证，因此在其用于常规临床实践之前需要进一步研究。(C)2011爱思唯尔有限公司保留所有权利。
In order to evaluate the use of an algorithm based on a procalcitonin (PCT) cut-off value as a means of guiding antibiotic therapy, 319 hospitalised children with uncomplicated community-acquired pneumonia (CAP) were randomised 1:1 to be treated on the basis of the algorithm or in accordance with standard guidelines. The children in the PCT group did not receive antibiotics if their PCT level upon admission was 0.25 ng/mL. The final analysis was based on 155 patients in the PCT group and 155 in the control group. In comparison with the controls, the PCT group received significantly fewer antibiotic prescriptions (85.8% vs 100%; p < 0.05), were exposed to antibiotics for a shorter time (5.37 vs 10.96 days; p < 0.05), and experienced fewer antibiotic-related adverse events (3.9% vs 25.2%; p < 0.05), regardless of CAP severity. There was no significant between-group difference in recurrence of respiratory symptoms and new antibiotic prescription in the month following enrollment. The results of this first prospective study using a PCT cut-off value to guide antibiotic therapy for pediatric CAP showed that this approach can significantly reduce antibiotic use and antibiotic-related adverse events in children with uncomplicated disease. However, because the study included mainly children with mild to moderate CAP and the risk of the use of the algorithm-based approach was not validated in a relevant number of severe cases, further studies are needed before it can be used in routine clinical practice. (C) 2011 Elsevier Ltd. All rights reserved.