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Antibiotic Selection00:57

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Decision-making is a fundamental cognitive process that involves evaluating alternatives and selecting among them. This process can range from simple choices, such as deciding what to wear, to complex decisions, like choosing a major in college or a career path. The complexity of the decision often dictates the approach we use, which can be broadly categorized into two types: automatic and controlled decision-making.
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Antibiotic Dereplication Using the Antibiotic Resistance Platform
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Procalcitonin to guide antibiotic decision making.

Angela Branche1,2, Olivia Neeser3, Beat Mueller3,4

  • 1Department of Medicine, University of Rochester.

Current Opinion in Infectious Diseases
|January 17, 2019
PubMed
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Procalcitonin (PCT) guided antibiotic stewardship improves outcomes for respiratory infections and sepsis by reducing antibiotic use. However, consistent benefits depend on appropriate patient selection, assay sensitivity, and physician training for optimal results.

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Area of Science:

  • Infectious Diseases
  • Clinical Microbiology
  • Critical Care Medicine

Background:

  • Antibiotic stewardship programs aim to optimize antibiotic use.
  • Procalcitonin (PCT) is an infection marker used in guiding antibiotic therapy.
  • Recent evidence shows mixed results regarding PCT's benefit in clinical practice.

Purpose of the Study:

  • To review the benefits and limitations of using PCT in infection management.
  • To discuss PCT's role in early infection recognition, severity assessment, and treatment decisions.
  • To analyze recent study data on PCT-guided care.

Main Methods:

  • Review of randomized trials and meta-analyses on PCT-guided antibiotic stewardship.
  • Analysis of studies on PCT's utility in different patient populations and clinical scenarios.
  • Evaluation of factors influencing PCT's effectiveness, including protocol adherence and assay sensitivity.

Main Results:

  • PCT-guided stewardship reduces antibiotic use and side effects, improving survival in sepsis and respiratory infections.
  • Initial PCT levels help assess bacterial infection risk in low pretest probability patients.
  • Serial PCT measurements aid in monitoring recovery and discontinuing antibiotics safely in higher-risk patients.
  • Some trials show no benefit, potentially due to low adherence, single measurements, or lower antibiotic exposure in controls.

Conclusions:

  • PCT inclusion in stewardship algorithms can enhance diagnosis and treatment for respiratory illnesses and sepsis.
  • PCT holds promise for combating antimicrobial resistance and enabling personalized medicine.
  • Effective PCT implementation requires careful patient selection, high-sensitivity assays, and physician training.