Simple blood test reduces antibiotic use in patients with acute respiratory infections

Professor Yahya Shehabi

Patients with acute respiratory infections should be tested for a blood marker for bacterial infection to determine antibiotic treatment, according to a large international study including researchers at Monash University.

Published yesterday in The Lancet ID, an individual patient data analysis from 26 randomised controlled trials across 12 countries was used to investigate the use of procalcitonin—a biomarker for bacterial infections—as a tool to improve decisions about antibiotic therapy.

Acute respiratory infections (ARIs) comprise a large group of infections including bacterial, viral and from other causes, accounting for over 10% of global disease burden. 

In these patients, “despite their mainly viral cause, unnecessary antibiotics significantly contribute to bacterial resistance, medical costs and the risk of drug-related side effects”, said co-author Professor Yahya Shehabi from Monash University who is also a critical care physician at Monash Health.  

“Blood levels of Procalcitonin (PCT) is negligible in normal people but rises substantially within hours of bacterial infection and decreases as patients recovers with appropriate antibiotic therapy.”

Randomised trials evaluated the use of procalcitonin based algorithms, to guide decision making for antibiotics prescription in acute respiratory infection. 

“Our individual patient meta-analysis, combining high quality trials using data from 6708 patients showed that the use of procalcitonin guided algorithms significantly reduced the risk of death by 17% and treatment failure by 12%.

“It also reduced antibiotic consumption and antibiotic-related side effects (16.3% versus 22.1%).”

“Our analysis also demonstrated that the benefits for sicker patients, like those needing intensive care treatment, is more pronounced.”  

 “Procalcitonin can be measured in the blood of patients at point of care providing clinicians with on the spot decision making for individual patients,” said Professor Shehabi, the only Australian author on the study.