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Randomized Controlled Trial
. 2013 Aug 6;8(8):e68419.
doi: 10.1371/journal.pone.0068419. Print 2013.

Procalcitonin guidance to reduce antibiotic treatment of lower respiratory tract infection in children and adolescents (ProPAED): a randomized controlled trial

Gurli Baer  1 , Philipp Baumann, Michael Buettcher, Ulrich Heininger, Gerald Berthet, Juliane Schäfer, Heiner C Bucher, Daniel Trachsel, Jacques Schneider, Muriel Gambon, Diana Reppucci, Jessica M Bonhoeffer, Jody Stähelin-Massik, Philipp Schuetz, Beat Mueller, Gabor Szinnai, Urs B Schaad, Jan Bonhoeffer
Affiliations
Randomized Controlled Trial

Procalcitonin guidance to reduce antibiotic treatment of lower respiratory tract infection in children and adolescents (ProPAED): a randomized controlled trial

Gurli Baer et al. PLoS One. .

Abstract

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 http://www.controlled-trials.com/ISRCTN17057980.

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Conflict of interest statement

Competing Interests: HCB received an unrestricted research grant from B.R.A.H.M.S. unrelated to this study. PS has received support from B.R.A.H.M.S. and Biomerieux to attend meetings and fulfill speaking engagements unrelated to this study. BM served as a consultant and received research support from B.R.A.H.M.S. and BioMerieux. All other authors have no conflict of interest. No commercial sponsor had any involvement in design and conduct of the study, namely collection, management, analysis, and interpretation of the data; and preparation, decision to submit, review, or approval of the manuscript. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Trial profile.
Figure 2
Figure 2. Antibiotic prescribing rate.
Antibiotic treatment by day since randomization for all children and adolescents with lower respiratory tract infections (LRTI) and for pre-specified subgroups according to PCT guidance and control. (A) All lower respiratory tract infections; (B) Community-acquired pneumonia (CAP); (C) Bronchitis and Bronchiolitis (non-CAP LRTI).
Figure 3
Figure 3. Duration of antibiotic treatment.
Box plots of the distribution of the duration of antibiotic (AB) treatment (in days) for children and adolescents with lower respiratory tract infection (LRTI) in the procalcitonin (PCT) and control group.
Figure 4
Figure 4. Impairment of daily activities.
Impairment of daily activities attributable to lower respiratory tract infection (LRTI) over time in 267 children and adolescents who returned diaries in the procalcitonin (PCT) and control group. The smooth curves are local averages calculated using the default loess smoother in R.
See this image and copyright information in PMC

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