Procalcitonin and lung ultrasonography point-of-care testing to determine antibiotic prescription in patients with lower respiratory tract infection in primary care: pragmatic cluster randomised trial.
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BORIS DOI
Date of Publication
September 21, 2021
Publication Type
Article
Division/Institute
Contributor
Lhopitallier, Loïc | |
Meuwly, Jean-Yves | |
Locatelli, Isabella | |
Mueller, Yolanda | |
Senn, Nicolas | |
D'Acremont, Valérie | |
Boillat-Blanco, Noémie |
Series
BMJ
ISSN or ISBN (if monograph)
1756-1833
Publisher
BMJ Publishing Group
Language
English
Publisher DOI
PubMed ID
34548312
Description
OBJECTIVE
To assess whether point-of care procalcitonin and lung ultrasonography can safely reduce unnecessary antibiotic treatment in patients with lower respiratory tract infections in primary care.
DESIGN
Three group, pragmatic cluster randomised controlled trial from September 2018 to March 2020.
SETTING
60 Swiss general practices.
PARTICIPANTS
One general practitioner per practice was included. General practitioners screen all patients with acute cough; patients with clinical pneumonia were included.
INTERVENTIONS
Randomisation in a 1:1:1 of general practitioners to either antibiotics guided by sequential procalcitonin and lung ultrasonography point-of-care tests (UltraPro; n=152), procalcitonin guided antibiotics (n=195), or usual care (n=122).
MAIN OUTCOMES
Primary outcome was proportion of patients in each group prescribed an antibiotic by day 28. Secondary outcomes included duration of restricted activities due to lower respiratory tract infection within 14 days.
RESULTS
60 general practitioners included 469 patients (median age 53 years (interquartile range 38-66); 278 (59%) were female). Probability of antibiotic prescription at day 28 was lower in the procalcitonin group than in the usual care group (0.40 v 0.70, cluster corrected difference -0.26 (95% confidence interval -0.41 to -0.10)). No significant difference was seen between UltraPro and procalcitonin groups (0.41 v 0.40, -0.03 (-0.17 to 0.12)). The median number of days with restricted activities by day 14 was 4 days in the procalcitonin group and 3 days in the usual care group (difference 1 day (95% confidence interval -0.23 to 2.32); hazard ratio 0.75 (95% confidence interval 0.58 to 0.97)), which did not prove non-inferiority.
CONCLUSIONS
Compared with usual care, point-of-care procalcitonin led to a 26% absolute reduction in the probability of 28 day antibiotic prescription without affecting patients' safety. Point-of-care lung ultrasonography did not further reduce antibiotic prescription, although a potential added value cannot be excluded, owing to the wide confidence intervals.
TRIAL REGISTRATION
ClinicalTrials.gov NCT03191071.
To assess whether point-of care procalcitonin and lung ultrasonography can safely reduce unnecessary antibiotic treatment in patients with lower respiratory tract infections in primary care.
DESIGN
Three group, pragmatic cluster randomised controlled trial from September 2018 to March 2020.
SETTING
60 Swiss general practices.
PARTICIPANTS
One general practitioner per practice was included. General practitioners screen all patients with acute cough; patients with clinical pneumonia were included.
INTERVENTIONS
Randomisation in a 1:1:1 of general practitioners to either antibiotics guided by sequential procalcitonin and lung ultrasonography point-of-care tests (UltraPro; n=152), procalcitonin guided antibiotics (n=195), or usual care (n=122).
MAIN OUTCOMES
Primary outcome was proportion of patients in each group prescribed an antibiotic by day 28. Secondary outcomes included duration of restricted activities due to lower respiratory tract infection within 14 days.
RESULTS
60 general practitioners included 469 patients (median age 53 years (interquartile range 38-66); 278 (59%) were female). Probability of antibiotic prescription at day 28 was lower in the procalcitonin group than in the usual care group (0.40 v 0.70, cluster corrected difference -0.26 (95% confidence interval -0.41 to -0.10)). No significant difference was seen between UltraPro and procalcitonin groups (0.41 v 0.40, -0.03 (-0.17 to 0.12)). The median number of days with restricted activities by day 14 was 4 days in the procalcitonin group and 3 days in the usual care group (difference 1 day (95% confidence interval -0.23 to 2.32); hazard ratio 0.75 (95% confidence interval 0.58 to 0.97)), which did not prove non-inferiority.
CONCLUSIONS
Compared with usual care, point-of-care procalcitonin led to a 26% absolute reduction in the probability of 28 day antibiotic prescription without affecting patients' safety. Point-of-care lung ultrasonography did not further reduce antibiotic prescription, although a potential added value cannot be excluded, owing to the wide confidence intervals.
TRIAL REGISTRATION
ClinicalTrials.gov NCT03191071.
File(s)
| File | File Type | Format | Size | License | Publisher/Copright statement | Content | |
|---|---|---|---|---|---|---|---|
| bmj.n2132.full.pdf | text | Adobe PDF | 442.88 KB | published |