Procalcitonin-Guided Antibiotic Theraphy in pediatric patients: A systematic review

ABSTRACT

Background@#Serum procalcitonin is a useful biomarker in establishing the presence of bacterial infections and has been used in algorithms to guide antibiotic treatment among adults. It role in pediatric infections, however, remains unclear. @*Objectives@#This research aims to evaluate the impact of serum procalcitonin in guiding antibiotic therapy among pediatric patients with suspected local or systemic infections. @*Methodology@#Randomized controlled trials comparing procalcitonin-guided antibiotic therapy to clinically guided therapy in pediatric patients with local or systemic infections were searched through MEDLINE, Cochrane, EMBASE, HERDIN and ClinicalTrials.gov. Hand search in various search engines was also done. Outcomes included antibiotic usage, morbidity and mortality. Two reviewers independently assessed potentially relevant studies. Statistical analysis was conducted using RevMan 5.3 using inverse variance weighting and random effects model. @*Results@#Five randomized controlled trials were included. Overall, there was a reduction in antibiotic prescription rate in the procalcitonin group compared to controls for all groups (RD -0.13, 95% CI [-021,0.06]; p <0.00001), however, pooled studies were heterogenous. Subgroup analysis showed that for children with pneumonia, procalcitonin guidance significantly reduced antibiotic prescription rate (RD – 012,95% CI [-021,0.04]; p <0.005 ), and may have potential in reducing the duration of therapy (95% CI [-6.8,2,54], p <0.0001) and antibiotic-related adverse effects (RD- 0.17, 95% CI[-0.24,-0.10], p<0.00001) compared to controls. In one study on neonates with early onset sepsis, procalcitonin guidance reduced antibiotic prescription rate by 27% (p=0.0009) and duration of therapy by 22.4 hours (p=0.0009). Procalcitonin guidance has no significant impact on antibiotic prescription rate in children with fever without a source (RD -0.11, 95% CI[0.28,0.05], p=0.190). @*Conclusion@#Procalcitonin guidance significantly reduces antibiotic prescription rate among children with pneumonia and neonates with early onset sepsis. It has the potential in reducing the duration of antibiotic therapy and antibiotic-related side effects in these populations. ON the other hand, it had no impact among children with fever without a source. These results highlight the need for algorithm-based approaches using procalcitonin cut-off values to guide antibiotic therapy in children.