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.

Details

Serval ID
serval:BIB_7CF9A518CF30
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
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.
Journal
BMJ
Author(s)
Lhopitallier L., Kronenberg A., Meuwly J.Y., Locatelli I., Mueller Y., Senn N., D'Acremont V., Boillat-Blanco N.
ISSN
1756-1833 (Electronic)
ISSN-L
0959-8138
Publication state
Published
Issued date
21/09/2021
Peer-reviewed
Oui
Volume
374
Pages
n2132
Language
english
Notes
Publication types: Journal Article ; Pragmatic Clinical Trial ; Randomized Controlled Trial
Publication Status: epublish
Abstract
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.
Three group, pragmatic cluster randomised controlled trial from September 2018 to March 2020.
60 Swiss general practices.
One general practitioner per practice was included. General practitioners screen all patients with acute cough; patients with clinical pneumonia were included.
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).
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.
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.
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.
ClinicalTrials.gov NCT03191071.
Keywords
Adult, Aged, Anti-Bacterial Agents/therapeutic use, Biomarkers/analysis, Cluster Analysis, Drug Prescriptions/statistics & numerical data, Female, General Practice, Humans, Intention to Treat Analysis, Lung/diagnostic imaging, Male, Middle Aged, Point-of-Care Testing, Primary Health Care/methods, Procalcitonin/blood, Respiratory Tract Infections/diagnosis, Respiratory Tract Infections/drug therapy, Ultrasonography/methods
Pubmed
Web of science
Open Access
Yes
Create date
27/09/2021 8:47
Last modification date
09/10/2021 5:38
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