Schuetz et al developed algorithms for guiding antibiotic therapy in various situations using the serum procalcitonin concentration. The authors are from Harvard School of Public Health, Massachusetts General Hospital and McMaster University.
Patient selection: high risk (high acuity) infection or sepsis
Parameters:
(1) serum procalcitonin concentration in µg/L on admission
(2) serum procalcitonin concentration in µg/L every 1-2 days
(3) clinical status and evidence of infection
Antibiotics are started on admission if one or both of the following are present:
Antibiotic therapy is strongly discouraged if both of the following are present:
(1) the serum procalcitonin is < 0.25 µg/L
(2) the patient is stable and at low risk for an adverse outcome
Initial Management
Followup Decisions
antibiotics started
continue or change regimen if the procalcitonin level does not decline or if the patient does not improve clinically; consider treatment failure if procalcitonin does not drop adequately
antibiotics started
strongly consider discontinuing antibiotics if serum procalcitonin < 0.25 µg/L or drops by > 90%; consider stopping antibiotics if procalcitonin 0.25 to 0.49 µg/L or drops 80-90%
antibiotics not started
start antibiotics if serum procalcitonin >= 0.50 µg/L or patient deteriorates
antibiotics not started
consider discharge if serum procalcitonin continues to be low and the patient is improving
To read more or access our algorithms and calculators, please log in or register.
