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  1. Erik Skyllberg
  1. Correspondence to Dr Erik Skyllberg, Acute Medicine, Royal London Hospital, London E1 1BB, UK; Erik.Skyllberg{at}bartshealth.nhs.uk

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Procalcitonin-guided therapy in respiratory infections

Procalcitonin is an acute-phase reactant with improved discriminatory value for bacterial infection compared with traditional markers such as white cell count and C reactive protein. A meta-analysis performed by Schuetz et al (Lancet Infect Dis 2018;18:95–107) assessed mortality and treatment failure in patients with an acute respiratory infection receiving procalcitonin- guided therapy versus a control group. The study included 6708 individual patients from 26 trials. Procalcitonin-guided therapy was associated with lower mortality (adjusted OR 0.83, 95% CI 0.70 to 0.99, P=0.037), shorter treatment duration (8.0±6.5 days vs 9.4±6.2 days, P<0.0001) and fewer antibiotic-associated side effects (16% vs 22%, P<0.0001). However, there was no significant reduction in risk of treatment failure (adjusted OR 0.90, 95% CI 0.80 to 1.01, P=0.068). These effects were consistent across clinical settings and types of infections. There was no significant improvement in the duration of intensive care unit or hospital stays. These data support the use of procalcitonin-guided management in respiratory infections in a range of clinical settings to reduce antibiotic use and may improve mortality.

Early adulthood lung function to predict old age health

Agusti et al …

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