Medical Dialogues
  • Dermatology
Login Register
This site is intended for healthcare professionals only
Login Register
  • MD Brand Connect
  • Vaccine Hub
  • MDTV
    • Breaking News
    • Medical News Today
    • Health News Today
    • Latest
    • Journal Club
    • Medico Legal Update
    • Latest Webinars
    • MD Shorts
    • Health Dialogues
  • Fact Check
  • Health Dialogues
Medical Dialogues
  • Medical News & Guidelines
      • Anesthesiology
      • Cardiology and CTVS
      • Critical Care
      • Dentistry
      • Dermatology
      • Diabetes and Endocrinology
      • ENT
      • Gastroenterology
      • Medicine
      • Nephrology
      • Neurology
      • Obstretics-Gynaecology
      • Oncology
      • Ophthalmology
      • Orthopaedics
      • Pediatrics-Neonatology
      • Psychiatry
      • Pulmonology
      • Radiology
      • Surgery
      • Urology
      • Laboratory Medicine
      • Diet
      • Nursing
      • Paramedical
      • Physiotherapy
  • Health news
      • Doctor News
      • Government Policies
      • Hospital & Diagnostics
      • International Health News
      • Medical Organization News
      • Medico Legal News
      • NBE News
      • NMC News
  • Fact Check
      • Bone Health Fact Check
      • Brain Health Fact Check
      • Cancer Related Fact Check
      • Child Care Fact Check
      • Dental and oral health fact check
      • Diabetes and metabolic health fact check
      • Diet and Nutrition Fact Check
      • Eye and ENT Care Fact Check
      • Fitness fact check
      • Gut health fact check
      • Heart health fact check
      • Kidney health fact check
      • Medical education fact check
      • Men's health fact check
      • Respiratory fact check
      • Skin and hair care fact check
      • Vaccine and Immunization fact check
      • Women's health fact check
  • AYUSH
    • Ayurveda
    • Homeopathy
    • Siddha
    • Unani
    • Yoga
  • State News
      • Andaman and Nicobar Islands
      • Andhra Pradesh
      • Arunachal Pradesh
      • Assam
      • Bihar
      • Chandigarh
      • Chattisgarh
      • Dadra and Nagar Haveli
      • Daman and Diu
      • Delhi
      • Goa
      • Gujarat
      • Haryana
      • Himachal Pradesh
      • Jammu & Kashmir
      • Jharkhand
      • Karnataka
      • Kerala
      • Ladakh
      • Lakshadweep
      • Madhya Pradesh
      • Maharashtra
      • Manipur
      • Meghalaya
      • Mizoram
      • Nagaland
      • Odisha
      • Puducherry
      • Punjab
      • Rajasthan
      • Sikkim
      • Tamil Nadu
      • Telangana
      • Tripura
      • Uttar Pradesh
      • Uttrakhand
      • West Bengal
  • Medical Education
      • Ayush Education News
      • Dentistry Education News
      • Medical Admission News
      • Medical Colleges News
      • Medical Courses News
      • Medical Universities News
      • Nursing education News
      • Paramedical Education News
      • Study Abroad
  • Industry
      • Health Investment News
      • Health Startup News
      • Medical Devices News
      • Pharma News
      • Pharmacy Education News
      • Industry Perspective
  • MDTV
      • Health Dialogues MDTV
      • Health News today MDTV
      • Latest Videos MDTV
      • Latest Webinars MDTV
      • MD shorts MDTV
      • Medical News Today MDTV
      • Medico Legal Update MDTV
      • Top Videos MDTV
      • Health Perspectives MDTV
      • Journal Club MDTV
      • Medical Dialogues Show
This site is intended for healthcare professionals only
LoginRegister
Medical Dialogues
LoginRegister
  • Home
  • Medical news & Guidelines
    • Anesthesiology
    • Cardiology and CTVS
    • Critical Care
    • Dentistry
    • Dermatology
    • Diabetes and Endocrinology
    • ENT
    • Gastroenterology
    • Medicine
    • Nephrology
    • Neurology
    • Obstretics-Gynaecology
    • Oncology
    • Ophthalmology
    • Orthopaedics
    • Pediatrics-Neonatology
    • Psychiatry
    • Pulmonology
    • Radiology
    • Surgery
    • Urology
    • Laboratory Medicine
    • Diet
    • Nursing
    • Paramedical
    • Physiotherapy
  • Health news
    • Doctor News
    • Government Policies
    • Hospital & Diagnostics
    • International Health News
    • Medical Organization News
    • Medico Legal News
    • NBE News
    • NMC News
  • Fact Check
    • Bone Health Fact Check
    • Brain Health Fact Check
    • Cancer Related Fact Check
    • Child Care Fact Check
    • Dental and oral health fact check
    • Diabetes and metabolic health fact check
    • Diet and Nutrition Fact Check
    • Eye and ENT Care Fact Check
    • Fitness fact check
    • Gut health fact check
    • Heart health fact check
    • Kidney health fact check
    • Medical education fact check
    • Men's health fact check
    • Respiratory fact check
    • Skin and hair care fact check
    • Vaccine and Immunization fact check
    • Women's health fact check
  • AYUSH
    • Ayurveda
      • Ayurveda Giuidelines
      • Ayurveda News
    • Homeopathy
      • Homeopathy Guidelines
      • Homeopathy News
    • Siddha
      • Siddha Guidelines
      • Siddha News
    • Unani
      • Unani Guidelines
      • Unani News
    • Yoga
      • Yoga Guidelines
      • Yoga News
  • State News
    • Andaman and Nicobar Islands
    • Andhra Pradesh
    • Arunachal Pradesh
    • Assam
    • Bihar
    • Chandigarh
    • Chattisgarh
    • Dadra and Nagar Haveli
    • Daman and Diu
    • Delhi
    • Goa
    • Gujarat
    • Haryana
    • Himachal Pradesh
    • Jammu & Kashmir
    • Jharkhand
    • Karnataka
    • Kerala
    • Ladakh
    • Lakshadweep
    • Madhya Pradesh
    • Maharashtra
    • Manipur
    • Meghalaya
    • Mizoram
    • Nagaland
    • Odisha
    • Puducherry
    • Punjab
    • Rajasthan
    • Sikkim
    • Tamil Nadu
    • Telangana
    • Tripura
    • Uttar Pradesh
    • Uttrakhand
    • West Bengal
  • Medical Education
    • Ayush Education News
    • Dentistry Education News
    • Medical Admission News
    • Medical Colleges News
    • Medical Courses News
    • Medical Universities News
    • Nursing education News
    • Paramedical Education News
    • Study Abroad
  • Industry
    • Health Investment News
    • Health Startup News
    • Medical Devices News
    • Pharma News
      • CDSCO (Central Drugs Standard Control Organisation) News
    • Pharmacy Education News
    • Industry Perspective
  • Home
  • Critical Care
  • Critical Care Guidelines
  • Use of procalcitonin...

Use of procalcitonin for rational use of antibiotics: ISCCM Guidelines

Written By : Medha Baranwal |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2023-03-18T09:15:35+05:30  |  Updated On 18 March 2023 4:05 PM IST
Use of procalcitonin for rational use of antibiotics: ISCCM Guidelines
  • facebook
  • twitter
  • linkedin
  • whatsapp
  • Telegram
  • Email

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.

PCT in Lower Respiratory Tract Infections (LRTIs)

Recommendations

  • Baseline PCT should not be routinely measured for initiating antibiotics in all patients with CAP (community-acquired pneumonia).
  • Baseline PCT levels should be obtained in patients with severe CAP for subsequent de-escalation of antibiotics.
  • If indicated, baseline serum PCT should preferably be measured at admission.
  • Baseline PCT levels alone should not be used to withhold empiric antibiotic therapy in patients with LRTIs (PCT in lower respiratory tract infections), including CAP.
  • Based on clinical judgment, prompt initiation of optimal empiric antibiotic therapy is recommended in patients with LRTIs, including CAP.
  • Procalcitonin levels alone should not be used to differentiate between bacterial and viral etiology in patients with CAP.
  • Procalcitonin should be used, along with clinical judgement, to take decisions regarding de-escalation in patients with CAP regarding antibiotics beyond 5–7 days.
  • Procalcitonin levels of 0.5 ng/mL or a decline of 80% from baseline should be used for the de-escalation of antibiotics in severe CAP or patients requiring intensive care.
  • Baseline PCT levels alone should not be used to make the clinical decision regarding antibiotic initiation in patients with VAP (ventilator-associated pneumonia) and HAP (hospital acquired pneumonia).
  • Serial serum PCT level measurement, preferably every 48 hours, should be used in antibiotic de-escalation (UPP).
  • Procalcitonin should be used as a part of an antibiotic stewardship program for antibiotic de-escalation in patients with VAP on antibiotics beyond 7 days.
  • Procalcitonin levels of 0.5 ng/mL or a decline of 80% from baseline along with clinical criteria should be used for de-escalation in VAP and HAP.
  • A decline of 80% or more from baseline and clinical criteria can be used for de-escalation if baseline values are available.

PCT in Other Infections

Recommendations

  • Procalcitonin may be used to diagnose bacteremia in UTI (urinary tract infection) patients.
  • The authors suggest against using PCT as a marker of treatment outcome in patients with febrile UTI.
  • Procalcitonin alone should not be used to diagnose infection or spontaneous bacterial peritonitis (SBP) among patients with cirrhosis and end-stage liver disease.
  • Procalcitonin may be considered for diagnosing infection or SBP in combination with clinical and other laboratory parameters.
  • The authors recommend against the use of PCT for the diagnosis of acute severe pancreatitis.
  • Procalcitonin alone should not be used for the diagnosis of SBP.
  • Procalcitonin may be considered for diagnosing SBP in combination with clinical features.
  • Serum PCT alone should not be used to diagnose infection in immunocompromised patients.
  • Serum PCT should not be used to guide antibiotic therapy in immunocompromised patients.


Indian Journal of Critical Care Medicineantibiotic stewardshipantibioticsProcalcitoninsepsisantibiotic resistance
Source : Indian Journal of Critical Care Medicine
Medha Baranwal
Medha Baranwal

    MSc. Biotechnology

    Dr. Kamal Kant Kohli
    Dr. Kamal Kant Kohli

    Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751

    Show Full Article
    Next Story

    Editorial

    First Indian Consensus on Managing Refractory Gastroesophageal Reflux Disease Recommends Vonoprazan

    First Indian Consensus on Managing Refractory Gastroesophageal Reflux Disease Recommends Vonoprazan

    Re-visiting the Role of Pneumococcal Vaccination in Patients with Cardiovascular Diseases

    Re-visiting the Role of Pneumococcal Vaccination in Patients with Cardiovascular Diseases

    Prediabetes and the Mind: Unraveling Cognitive and Mental Health Risks

    Prediabetes and the Mind: Unraveling Cognitive and Mental Health Risks

    Real-World Case study: Darbepoetin Alfa for Chemotherapy-Induced Anemia in Metastatic Breast Cancer - Dr Aditya Murali

    Real-World Case study: Darbepoetin Alfa for Chemotherapy-Induced Anemia in Metastatic Breast Cancer...

    Aspirin in Primary Prevention- When to Consider?

    Aspirin in Primary Prevention- When to Consider?

    View All

    Journal Club Today

    Can Mindfulness Retrain the Brain to Reduce Anxiety? Study Sheds Light

    Can Mindfulness Retrain the Brain to Reduce Anxiety? Study Sheds Light

    View All

    Health News Today

    Health Bulletin 20/ May/ 2025

    Health Bulletin 20/ May/ 2025

    View All
    © 2022 All Rights Reserved.
    Powered By: Hocalwire
    X
    We use cookies for analytics, advertising and to improve our site. You agree to our use of cookies by continuing to use our site. To know more, see our Cookie Policy and Cookie Settings.Ok