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How Efficient Is Procalcitonin-Guided Antibiotic Use in Acute Respiratory Tract Infections in Primary Care?

How Efficient Is Procalcitonin-Guided Antibiotic Use in Acute Respiratory Tract Infections in... The antibiotic prescription for acute respiratory tract infection is still used with caution because there is no effective way to distinguish between viral and bacterial infection. Briel et al1 evaluated whether antibiotic therapy guided by procalcitonin reduces the use of antibiotics without increasing the restriction of activities experienced by patients compared with a standard therapy based on current guidelines. However, this primary end point—the restriction of activities as experienced by patients—is patient dependent and hard to replicate from one setting to another. It is not possible to capture its content and construct. Does it means work absence, no leisure time activity, lying in bed? The restriction of activities based on the condition of being sick is likely to be biased toward the education level of the patients. Even so, the unbalanced distribution of less-educated patients in the control group did not increase the number of days with restricted activity. Surprisingly, the intervention caused a remarkable reduction in the antibiotic prescription. It seems that physicians needed a tool to prevent themselves from prescribing antibiotics. As a matter of fact, the lack of antibiotic use did not cause any symptoms of ongoing or relapsing infection at 28 days, suggesting that patients did not need them anyway. Correspondence: Ms Brusius, Epidemiologia, Universidade Federal do Rio Grande do Sul, Av Jeronimo de Ornelas, Porto Alegre 90040-341, Brazil (abrusius@hcpa.ufrgs.br). References 1. Briel MSchuetz PMueller B et al. Procalcitonin-guided antibiotic use vs a standard approach for acute respiratory tract infections in primary care. Arch Intern Med 2008;168 (18) 2000- 2008PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

How Efficient Is Procalcitonin-Guided Antibiotic Use in Acute Respiratory Tract Infections in Primary Care?

How Efficient Is Procalcitonin-Guided Antibiotic Use in Acute Respiratory Tract Infections in Primary Care?

Abstract

The antibiotic prescription for acute respiratory tract infection is still used with caution because there is no effective way to distinguish between viral and bacterial infection. Briel et al1 evaluated whether antibiotic therapy guided by procalcitonin reduces the use of antibiotics without increasing the restriction of activities experienced by patients compared with a standard therapy based on current guidelines. However, this primary end point—the restriction of activities as...
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Publisher
American Medical Association
Copyright
Copyright © 2009 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinternmed.2009.182
Publisher site
See Article on Publisher Site

Abstract

The antibiotic prescription for acute respiratory tract infection is still used with caution because there is no effective way to distinguish between viral and bacterial infection. Briel et al1 evaluated whether antibiotic therapy guided by procalcitonin reduces the use of antibiotics without increasing the restriction of activities experienced by patients compared with a standard therapy based on current guidelines. However, this primary end point—the restriction of activities as experienced by patients—is patient dependent and hard to replicate from one setting to another. It is not possible to capture its content and construct. Does it means work absence, no leisure time activity, lying in bed? The restriction of activities based on the condition of being sick is likely to be biased toward the education level of the patients. Even so, the unbalanced distribution of less-educated patients in the control group did not increase the number of days with restricted activity. Surprisingly, the intervention caused a remarkable reduction in the antibiotic prescription. It seems that physicians needed a tool to prevent themselves from prescribing antibiotics. As a matter of fact, the lack of antibiotic use did not cause any symptoms of ongoing or relapsing infection at 28 days, suggesting that patients did not need them anyway. Correspondence: Ms Brusius, Epidemiologia, Universidade Federal do Rio Grande do Sul, Av Jeronimo de Ornelas, Porto Alegre 90040-341, Brazil (abrusius@hcpa.ufrgs.br). References 1. Briel MSchuetz PMueller B et al. Procalcitonin-guided antibiotic use vs a standard approach for acute respiratory tract infections in primary care. Arch Intern Med 2008;168 (18) 2000- 2008PubMedGoogle ScholarCrossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jul 13, 2009

Keywords: antibiotics,primary health care,respiratory tract infections,procalcitonin

References

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