Role of procalcitonin in guiding antibiotic therapy.

Dec 2012

Fazili T, Endy T, Javaid W, Maskey M.

Abstract

Purpose The role of procalcitonin in guiding antibiotic therapy is reviewed. Summary Procalcitonin is a prohormone for calcitonin, which is secreted by the parafollicular cells of the thyroid gland. The biological activity of procalcitonin is significantly different from calcitonin and is believed to be part of the complex inflammatory cascade of the immune system. Procalcitonin has been shown to be elevated in bacterial infections but not in viral infections or other inflammatory conditions. The first published study that suggested that procalcitonin levels increased in the presence of bacterial infection was conducted in France in the early 1990s. Numerous studies have been conducted using procalcitonin-guided therapy to reduce antibiotic use. These studies were performed in one of three clinical settings: outpatient primary care (two multicenter, noninferiority studies of patients with upper- and lower-respiratory-tract infections), emergency room and inpatient (five studies in patients with chronic obstructive pulmonary disease, exacerbation, bronchitis, or community-acquired pneumonia), and the intensive care unit (ICU) (two studies in medical ICU patients and two in postoperative ICU patients with infection or sepsis). Based on the findings of these studies, a cutoff value of 0.25 μg/L in non-ICU patients or of 0.5 μg/L in ICU patients seems appropriate for making a decision about the initiation and discontinuation of antibiotic therapy. In patients with a significantly elevated baseline procalcitonin level, a subsequent drop of >80% appears to be reasonable for discontinuing antibiotics. Conclusion Published evidence supports the use of procalcitonin as a biomarker of bacterial infection that can be used to reduce antibiotic exposure.

PubMed

Antibiotics Aren't Always the Answer

Nov 2012

Antibiotics do not fight infections caused by viruses like colds, most sore throats and bronchitis, and some ear infections. Unneeded antibiotics may lead to future antibiotic-resistant infections. Symptom relief might be the best treatment option.

Dangers of Antibiotic Resistance

Colds and many other upper respiratory infections, as well as some ear infections, are caused by viruses, not bacteria. If antibiotics are used too often for things they can't treat—like colds or other viral infections—they can stop working effectively against bacteria when you or your child really needs them. Antibiotic resistance—when antibiotics can no longer cure bacterial infections—has been a concern for years and is considered one of the world's most critical public health threats.

CDC efforts have resulted in fewer children receiving unnecessary antibiotics in recent years, but inappropriate use remains a problem. Widespread overuse and inappropriate use of antibiotics continues to fuel an increase in antibiotic-resistant bacteria.So the next time you or your child really needs an antibiotic for a bacterial infection, it may not work.

Antibiotic resistance is also an economic burden on the entire healthcare system. Resistant infections cost more to treat and can prolong healthcare use.

If You or Your Child Has a Virus Like a Cold or Sore Throat

Taking antibiotics when you or your child has a virus may do more harm than good. In fact, in children, antibiotics are the most common cause of emergency department visits for adverse drug events. Rest, fluids, and over-the-counter products may be your or your child's best treatment option.

Get smart about when antibiotics are appropriate—to fight bacterial infections. Taking them for viral infections, such as a cold, most sore throats, acute bronchitis and many sinus or ear infections:

• Will not cure the infection
• Will not keep other people from getting sick
• Will not help you or your child feel better
• May cause unnecessary and harmful side effects

What Not to Do

• Do not demand antibiotics when a doctor says they are not needed.
• Do not take an antibiotic for a viral infection like a cold or most sore throats.
• Do not take antibiotics prescribed for someone else. The antibiotic may not be right for your or your child's illness. Taking the wrong medicine may delay correct treatment and allow bacteria to increase.

If your doctor prescribes an antibiotic for bacterial infection:

• Do not skip doses.
• Do not save any of the antibiotics for the next time you or your child gets sick.

What to Do

Just because your doctor doesn't give you an antibiotic doesn't mean you aren't sick.

Talk with your doctor about the best treatment for your or your child's illness. To feel better when you or your child has an upper respiratory infection:

• Ask your doctor or pharmacist about over-the-counter treatment options that may help reduce symptoms
• Increase fluid intake
• Get plenty of rest
• Use a cool-mist vaporizer or saline nasal spray to relieve congestion
• Soothe a throat with ice chips, sore throat spray, or lozenges (do not give lozenges to young children)

Video: Parents Want To Do What’s Best

When your child is sick, antibiotics may not be the answer. Work with your child's doctor or nurse to learn how you can help your child feel better. CDC created a 30-second TV public service announcement to highlight this important information.

CDC 

Antibiotic use in acute upper respiratory tract infections.

Nov 2012

Zoorob R, Sidani MA, Fremont RD, Kihlberg C.

Source

Meharry Medical College, Nashville, TN, USA.

Abstract

Upper respiratory tract infections account for millions of visits to family physicians each year in the United States. Although warranted in some cases, antibiotics are greatly overused. This article outlines the guidelines and indications for appropriate antibiotic use for common upper respiratory infections. Early antibiotic treatment may be indicated in patients with acute otitis media, group A beta-hemolytic streptococcal pharyngitis, epiglottitis, or bronchitis caused by pertussis. Persistent cases of rhinosinusitis may necessitate the use of antibiotics if symptoms persist beyond a period of observation. Antibiotics should not be considered in patients with the common cold or laryngitis. Judicious, evidence-based use of antibiotics will help contain costs and prevent adverse effects and drug resistance.

PubMed