In-office procalcitonin testing can lead to less antibiotic prescribing

Reference

Lhopitallier L, Kronenberg A, Meuwly JY, et al. Procalcitonin and lung ultrasonography point-of-care testing to decide on antibiotic prescription in patients with lower respiratory tract infection in primary care: protocol of a pragmatic cluster randomized trial. BMC Pulm Med. 2019 Aug 6;19(1):143.

Synopsis

This study enrolled 60 general practitioners in Switzerland who were randomized to use procalcitonin testing alone, procalcitonin testing followed by in-office ultrasound after high (> 0.25 mcg/L) test results, or usual care of patients with lower respiratory tract infections, including presumptive pneumonia. The physicians were trained in the use of algorithms to determine how the testing results should guide antibiotic use, but the decision to prescribe was left to them. At the time of initial consultation, 18% of patients tested with procalcitonin (with or without ultrasound) received antibiotic treatment as compared with 57% of usual care patients (P <.05). By day 28 after initial consultation, 40% of procalcitonin-tested patients and 70% of patients in the usual care received antibiotic treatment (P <.05). Only 9 patients received lung ultrasound so there may be a benefit left to be uncovered with further study in more patients. There was no difference in clinical failure rate by day 7 or in serious adverse outcomes over the 28 days among the groups. There is a possibility of a Hawthorne effect (i.e., the physicians prescribed antibiotic therapy less often because they knew they were being studied).