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PRO: Procalcitonin has clinical utility in children with community-acquired pneumonia

Todd A Florin1, Derek J Williams2

  • 1Department of Pediatrics, Northwestern University Feinberg School of Medicine and Division of Pediatric Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.

Jac-Antimicrobial Resistance
|October 24, 2022
PubMed

Insights

Procalcitonin (PCT) testing can help doctors decide when to use antibiotics in children with respiratory infections. A very low PCT level suggests a low risk of bacterial infection, potentially reducing unnecessary antibiotic prescriptions.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Clinical Diagnostics

Background:

  • Lower respiratory tract infections (LRTI) are common in children, frequently leading to antibiotic prescriptions.
  • Viral infections often cause paediatric LRTI, yet bacterial infections are commonly suspected, leading to over-prescription of antibiotics.
  • Procalcitonin (PCT) is a biomarker investigated for guiding antibiotic stewardship.

Purpose of the Study:

  • To evaluate the utility of procalcitonin (PCT) in managing antibiotic use for paediatric lower respiratory tract infections (LRTI), including community-acquired pneumonia (CAP).
  • To assess the negative predictive value of low PCT concentrations in identifying children with LRTI at low risk for bacterial infections.

Main Methods:

  • Review of recent data on PCT concentrations in children with LRTI.
  • Analysis of the negative predictive value of low PCT levels.
  • Comparison of PCT utility in paediatric versus adult LRTI studies.

Main Results:

  • Very low PCT concentrations demonstrate a high negative predictive value for typical bacterial infections in children with LRTI.
  • PCT can aid clinicians in making informed decisions regarding antibiotic initiation or discontinuation.
  • The potential benefit of PCT is particularly significant in paediatric CAP where viral causes are prevalent.

Conclusions:

  • Procalcitonin is a valuable, though not perfect, diagnostic tool for antibiotic decision-making in paediatric LRTI.
  • Utilizing PCT can help reduce unnecessary antibiotic exposure in children, especially in cases of community-acquired pneumonia.
  • Further research supports PCT's role in optimizing antibiotic stewardship in paediatric respiratory infections.

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