Journal article
Guideline-Based Clinical Assessment Versus Procalcitonin-Guided Antibiotic Use in Pneumonia: A Pragmatic Randomized Trial
Annals of emergency medicine, Vol.74(4), pp.580-591
10/2019
DOI: 10.1016/j.annemergmed.2019.02.025
PMID: 30982631
Abstract
Efforts to reduce unnecessary and unnecessarily long antibiotic treatment for community-acquired pneumonia have been attempted through use of procalcitonin and through guidelines based on serial clinical assessment. Our aim is to compare guideline-based clinical assessment- and procalcitonin algorithm-guided antibiotic use among patients with community-acquired pneumonia.
We performed a pragmatic, randomized, multicenter trial from November 2012 to April 2015 at 12 French hospitals. We included emergency department (ED) patients older than 18 years with community-acquired pneumonia. Patients were randomly assigned to either the procalcitonin-guided or clinical assessment group. In accordance with past studies, we hypothesized that serial clinical assessment would be superior to procalcitonin-guided care. The primary outcome was antibiotic duration, and secondary outcomes included rates of antibiotic duration less than or equal to 5 days, and clinical success and combined serious adverse outcomes at 30 days in the intention-to-treat population.
Of 370 eligible patients, 285 (77%) were randomly assigned to either clinical assessment- (n=143) or procalcitonin-guided care (n=142). Median age was 67 years (range 18 to 93 years) and 40% of patients were deemed to have Pneumonia Severity Index class IV or V. Procalcitonin algorithm adherence was 76%. Antibiotic duration was not significantly different between clinical assessment- and procalcitonin-guided groups (median 9 versus 10 days, respectively). Clinical success rate was 92% in each group and serious adverse outcome rates were similar (15% versus 20%, respectively).
Guideline-based serial clinical assessment did not reduce antibiotic exposure compared with procalcitonin-guided care among ED patients with community-acquired pneumonia. The strategies were similar in terms of duration of antibiotic use and clinical outcomes.
Details
- Title: Subtitle
- Guideline-Based Clinical Assessment Versus Procalcitonin-Guided Antibiotic Use in Pneumonia: A Pragmatic Randomized Trial
- Creators
- Emmanuel Montassier - Centre Hospitalier Universitaire de NantesFrançois Javaudin - Centre Hospitalier Universitaire de NantesFarès Moustafa - Centre Hospitalier Universitaire de Clermont-FerrandDemeno Nandjou - Centre Hospitalier Agen - NéracMaxime Maignan - Centre Hospitalier Universitaire de GrenobleJean-Benoit Hardouin - Nantes UniversitéCaroline Annoot - Centre Hospitalier Départemental VendéeMaja Ogielska - Centre Hospitalier Universitaire de ToursPascal-Louis Orer - Hôpital AvicenneThibault Schotté - Centre Hospitalier Universitaire d'AngersJacques Bouget - Centre Hospitalier Universitaire de RennesSyamak Agha Babaei - Department of Emergency Medicine, Centre Hospitalier Universitaire Strasbourg, Strasbourg, FrancePierre-Alexis Raynal - Hôpital Saint-AntoineAntoine Eche - Hôtel-Dieu de ParisAlbert Trinh Duc - Centre Hospitalier Agen - NéracRuxandra-Aimée Cojocaru - Hôpitaux Universitaires de StrasbourgNesrine Benaouicha - Centre Hospitalier Universitaire de NantesGilles Potel - Centre Hospitalier Universitaire de NantesEric Batard - Centre Hospitalier Universitaire de NantesDavid A Talan - Los Angeles Medical Center
- Resource Type
- Journal article
- Publication Details
- Annals of emergency medicine, Vol.74(4), pp.580-591
- DOI
- 10.1016/j.annemergmed.2019.02.025
- PMID
- 30982631
- ISSN
- 0196-0644
- eISSN
- 1097-6760
- Grant note
- name: French Ministry of Health, award: PHRC API12/N/080
- Language
- English
- Date published
- 10/2019
- Academic Unit
- Emergency Medicine; Internal Medicine
- Record Identifier
- 9984297137702771
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