Use of procalcitonin for rational use of antibiotics: ISCCM Guidelines
New Delhi: A recent article published in the Indian Journal of Critical Care Medicine reports guidelines for using Procalcitonin (PCT) for rational antibiotics use.
The rapid emergence of antibiotic resistance is a global problem that compromises the progress of humankind in encountering infections and saving lives. Factors contributing to increased infection with multidrug-resistant organisms include natural selection and adaptation of microbes, immunosuppression, ageing, immunosuppression misuse and overuse of antimicrobial agents. To encounter this problem, two main approaches have been suggested. The first is to invest in new antibiotic discoveries, and the second is the optimal use of antibiotics; the latter approach has been refined into a new concept called antibiotic stewardship.
Several meta-analyses and randomized trials have addressed using PCT for antibiotic stewardship in hospital-acquired and community-acquired infections. This guideline by the Indian Society of Critical Care Medicine (ISCCM) frames evidence-based recommendations for serum PCT in antibiotic stewardship for various infections.
The recommendations are as given below:
PCT in sepsis
Recommendations
- Baseline serum PCT levels may be done in patients with sepsis.
- Procalcitonin alone should not be used for the diagnosis of sepsis.
- The authors suggest that PCT be used to differentiate culture-negative sepsis from non-sepsis.
- Procalcitonin levels can be used to support the discontinuation or de-escalation of antibiotics in patients with sepsis.
- Procalcitonin levels may be repeated every 72 hours or earlier if clinically indicated.
- Procalcitonin levels of less than 0.5 ng/mL or a drop by more than 80% from baseline should be used with clinical judgment for decision-making regarding antibiotic de-escalation.
- Procalcitonin may be used to define the severity of infection in a patient with sepsis.
- Physicians should be aware of infections where PCT is not a reliable marker.
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