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Effectiveness of Procalcitonin in Antibiotic Treatment for Children

Background

Procalcitonin is a marker that helps identify bacterial infections quickly, faster than other tests like C-reactive protein. However, it is not commonly used in the National Health Service (NHS).

Objective

The goal of this study was to see if using a procalcitonin-guided approach could safely shorten the time children in the hospital receive antibiotics compared to standard care.

Study Design

This was a practical, multicenter study conducted in various children’s hospitals and general hospitals across the UK. It involved children aged 72 hours to 18 years who were hospitalized and receiving intravenous antibiotics for suspected or confirmed infections.

Intervention

Participants were divided into two groups: one received treatment guided by procalcitonin levels, while the other received standard care.

Main Outcomes

The main outcomes measured were the duration of intravenous antibiotic use and safety of the treatment.

Results

From June 2018 to October 2022, 1949 children participated in the study. The length of time on intravenous antibiotics was similar between both groups (96 hours for the procalcitonin group vs. 99.7 hours for standard care). The procalcitonin approach did not significantly improve antibiotic duration and was not more cost-effective, costing £467.62 for each hour of antibiotics avoided.

Limitations

Many hospitals already had strong programs to manage antibiotic use. Additionally, adherence to the procalcitonin-guided approach was low, as doctors may not have been familiar with the test.

Conclusions

In children with suspected bacterial infections, adding a procalcitonin-guided approach to standard care did not reduce antibiotic use or costs. It may not provide extra benefits when good antibiotic management programs are already in place.

Future Work

Future studies should focus on better ways to implement these guidelines and provide ongoing training for healthcare professionals to use biomarker-guided approaches effectively.