Allergy Asthma Respir Dis.  2016 Jan;4(1):55-60. 10.4168/aard.2016.4.1.55.

Antibiotic therapy decision and clinical outcome comparison based on serum procalcitonin in children with pneumonia

Affiliations
  • 1Department of Pediatrics, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea. immlee@cnu.ac.kr
  • 2Department of Pediatrics, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea.
  • 3Department of Laboratory Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea.

Abstract

PURPOSE
It is difficult to differentiate between viral and bacterial pneumonia in children and to decide antibiotic therapy. Study was conducted to investigate the clinical usefulness of antibiotic therapy based on procalcitonin (PCT) in children diagnosed with viral pneumonia.
METHODS
This study included 108 patients diagnosed with viral pneumonia. Patient's age, fever duration, hospital stay, and treatment progress were noted, and laboratory study including PCT levels were tested. In addition, Polymerase chain reaction was done to test for viruses. Patients were divided into PCT and non-PCT groups according to PCT level. And their clinical patterns, treatment outcome, antibiotic use, severity of complications were compared.
RESULTS
The number of patients with respiratory syncytial virus (RSV) was 35 and 50, rhinovirus was 5 and 10 in PCT and non-PCT groups, respectively. Fever duration was longer by 2.5 days in PCT group than in the non-PCT group (P<0.001), but there was no difference in the duration of hospital stay (P=0.191). White blood cell and absolute neutrophil count levels were higher in the PCT group (P=0.013 and P<0.001, respectively). Use of antibiotic therapy was performed in group was on 22% and 90% of patients in the PCT and non-PCT groups, respectively showing a significant reduction in the frequency of antibiotic therapy in PCT group, without a significant difference in treatment outcome, despite more severe clinical signs (P<0.001).
CONCLUSION
Antibiotic therapy based on serum PCT levels in children admitted for pneumonia can reduce the frequency of antibiotic therapy in viral pneumonia, without causing significantly different treatment outcome or complications.

Keyword

Procalcitonin; Pneumonia; Child; Antibiotics

MeSH Terms

Anti-Bacterial Agents
Child*
Fever
Humans
Length of Stay
Leukocytes
Neutrophils
Pneumonia*
Pneumonia, Bacterial
Pneumonia, Viral
Polymerase Chain Reaction
Respiratory Syncytial Viruses
Rhinovirus
Treatment Outcome
Anti-Bacterial Agents

Figure

  • Fig. 1 Trial profile. AOM, acute otitis media; RDS, respiratory distress syndrome; PCT, procalcitonin.

  • Fig. 2 Modified procalcitonin (PCT) guided antibiotics therapy.

  • Fig. 3 Antibiotic use according to PCT-guidance strategy in children with viral pneumonia. The PCT group significantly showed lower rate of antibiotic use than non-PCT. PCT, procalcitonin.


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