Treatment of Elderly Patients With Community-Acquired Pneumonia With the Guidance of Procalcitonin

Abstract

PURPOSE: Procalcitonin, the precusor peptide of calcitonin, is released in response to a body's exposure to bacterial antigens or toxins. Serum levels of procalcitonin increase rapidly and its dynamics have prognostic implications in the presence of low respiratory infection. This study aims to assess the initiation and the duration of antibiotic treatment and the clinical outcome with the guidance of procalcitonin level for elderly patients with community‐acquired pneumonia METHODS: A total of 164 elderly patients(more than 70 of age) requiring hospitalization with community‐acquired pneumonia were randomized to procalcitonin‐guided or usual practice‐guided antibiotic treatment. The primary outcome was the initiation and the duration of antibiotic treatment. The secondary outcome was the clinical outcome and the length of hospitalization. In the procalcitonin group(n=80), antibiotics were initiated and discontinued on the basis of cutoff level(<0.25 ug/L). The control group(n=84) received antibiotics according to the usual practice guideline. Data were analyzed at baseline, day 5, 7, 10, 14 and 4w, 6w with antibiotic treatment, the clinical outcome and the length of hospitalization RESULTS: At baseline, both groups were similar regarding clinical characteristics. In the procalcitonin group, antibiotic prescriptions on admission(91.3 vs 98.8%, p<0.05) and the duration of antibiotic treatment (11.2 vs 14.6 p< 0.05) were reduced compared with the control group. There was no difference between two groups with respect to overall success rate of treatment(81.3 vs 83.8% p>0.05), 6 month mortality (13.8 vs 12.5%) and the length of hospitalization (14.6 vs 16d) CONCLUSIONS: Procalcitonin guidance for elderly community‐acquired pneumonia offers a sustained advantage over usual practice guideline therapy in reducing antibiotics prescriptions and the duration of antibiotic treatment. And similar result of treatment outcome were shown compared with patients treated with usual practice guideline.