Procalcitonin guided algorithm not effective in reducing intravenous antibiotic duration among kids: Study

Results

• Of the 15,282 children screened, 1949 were enrolled, of whom 977 were assigned to the procalcitonin group and 972 to the usual care group.

• The median duration was 96.0 hours (IQR 59.5–155.5) in the procalcitonin group and 99.7 hours (IQR 61.2–153.8) in the usual care group.

• The hazard ratio for the comparison of the two groups for antibiotic duration was 0.96 (95% CI: 0.87–1.05).

• In the procalcitonin group, 78 of 917 participants (9%) had events included in the composite safety outcome measure.

• Likewise, 85 of 904 participants (9%) in the usual care group had such events.

• The adjusted risk difference was –0.81% (95% CI upper bound: 1.11), thus meeting the predefined non-inferiority margin of 5%.

The BATCH trial concluded that a procalcitonin-guided algorithm neither significantly reduces the duration of intravenous antibiotic therapy nor offers safety advantages over usual care in hospitalized children with suspected bacterial infections. These findings highlight the efficacy of existing pediatric antibiotic stewardship programs in ensuring optimal treatment outcomes.

Reference:

Waldron, C.-A., Pallmann, P., Schoenbuchner, S., Harris, D., Brookes-Howell, L., Mateus, C., Bernatoniene, J., Cathie, K., Faust, S. N., Hinds, L., Hood, K., Huang, C., Jones, S., Kotecha, S., Nabwera, H. M., Patel, S., Paulus, S. C., Powell, C. V. E., Preston, J., … Rojas-Jimenz, E. (2025). Procalcitonin-guided duration of antibiotic treatment in children hospitalised with confirmed or suspected bacterial infection in the UK (BATCH): a pragmatic, multicentre, open-label, two-arm, individually randomised, controlled trial. The Lancet. Child & Adolescent Health. https://doi.org/10.1016/s2352-4642(24)00306-