2194. Procalcitonin-Guided Antibiotic Strategy for Lower Respiratory Tract Infections: Outcomes and Safety of Withholding Antibiotics

Abstract Background Procalcitonin (PCT) is a promising and well-studied marker in differentiating viral from bacterial lower respiratory tract infections (LRTI). Antibiotics are not recommended when PCT is normal (< 0.25 μg/L). Despite this, it has not been the standard of care due to safety concerns of relying on PCT to withhold antibiotics. Methods We retrospectively reviewed all non-critical LRTI patients with normal PCT admitted in our institution from October 2018 to March 2019. They were divided into adherent group in whom antibiotics were discontinued within 24 hours and non-adherent group in whom antibiotics were continued. Cases of Legionella, Mycoplasma, and other infectious syndromes necessitating antibiotics were excluded. Complexity of cases was measured based on Centers for Medicare and Medicaid Services (CMS) case-mix index (CMI). Outcomes compared were the length of stay (LOS), in-hospital mortality, and 30-day all-cause readmissions. Results A total of 78 patients were included in the analysis, 52% (n = 41) were in adherent group and 48% (n = 37) in the non-adherent group. The mean age was 74, and majority were females (59%, n = 46). The were no significant differences between the two groups in terms of age, gender, CMI, underlying COPD/asthma, CHF (see Table 1). The adherent group had statistically shorter LOS compared with the non-adherent group after adjusting for CMI. There was no significant difference in In-hospital mortality and readmissions (see Table 2). Furthermore, the adherent group’s LOS was statistically similar to CMS average LOS (5.08 vs. 3.8, P = 0.08); compared with the non-adherent group which had statistically longer LOS compared with CMS average LOS (8.3 vs. 4.6, p Conclusion PCT is a safe tool in deciding when to withhold antibiotics on LRTI patients. It shortens LOS with no difference in mortality or readmission. Disclosures All authors: No reported disclosures.

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Hospitalisation for lower respiratory tract infection in children in the province of Quebec, Canada, before and during the pneumococcal conjugate vaccine era

Epidemiology and Infection ◽

10.1017/s0950268817001510 ◽

2017 ◽

Vol 145 (13) ◽

pp. 2770-2776 ◽

Cited By ~ 4

Author(s):

G. ANDERSON ◽

G. DECEUNINCK ◽

Z. ZHOU ◽

F. D. BOUCHER ◽

Y. BONNIER VIGER ◽

...

Keyword(s):

Respiratory Tract ◽

Lower Respiratory Tract ◽

Respiratory Tract Infections ◽

Hospital Admissions ◽

Community Acquired Pneumonia ◽

Main Diagnosis ◽

Lower Respiratory Tract Infections ◽

Study Population ◽

The Mean ◽

Tract Infections

SUMMARYStreptococcus pneumoniaeis an important cause of community-acquired pneumonia and pneumococcal conjugate vaccines (PCVs) may reduce this burden. This study's goal was to analyse trends in lower respiratory tract infections (LRTI) hospitalisations before and during a routine vaccination programme targeting all newborns with PCV was started in the province of Quebec, Canada in December 2004. The study population included hospital admissions with a main diagnosis of LRTI among 6–59 month-old Quebec residents from April 2000 to December 2014. Trends in proportions and rates were analysed using Cochran-Armitage tests and Poisson regression models. We observed a general downward trend in all LTRI hospitalisations rate: from 11·55/1000 person-years in 2000–2001 to 9·59/1000 in 2013–2014, a 17·0% reduction, which started before the introduction of PCV vaccination. Downward trends in hospitalisation rates were more pronounced for all-cause of pneumonia (minus 17·8%) than for bronchiolitis (minus 15·4%). There was also a decrease in the mean duration of hospital stay. There was little evidence that all-cause pneumonia decreased over the study period due mainly to the introduction of PCVs. Trends may be related to changes in clinical practice. This study casts doubt on the interpretation of ecological analyses of the implementation of PCV vaccination programmes.

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Randomized, Multicentre, Comparative Clinical Evaluation of Cefuroxime–Sulbactam versus Amoxicillin–Clavulanic Acid Therapy in the Treatment of Lower Respiratory Tract Infections

Journal of International Medical Research ◽

10.1177/147323000803600617 ◽

2008 ◽

Vol 36 (6) ◽

pp. 1293-1304 ◽

Cited By ~ 1

Author(s):

A Pareek ◽

S Pednekar ◽

HB Prasad ◽

S Salagre ◽

N Chandurkar

Keyword(s):

Respiratory Tract ◽

Success Rate ◽

Clavulanic Acid ◽

Lower Respiratory Tract ◽

Respiratory Tract Infections ◽

Lower Respiratory Tract Infections ◽

Acid Therapy ◽

Significant Difference ◽

Amoxicillin Clavulanic Acid ◽

Tract Infections

This randomized, multicentre, comparative study evaluated the efficacy and safety of treatment with cefuroxime–sulbactam compared with amoxicillin–clavulanic acid (co-amoxiclav) in patients with lower respiratory tract infections (LRTIs). The study enrolled 75 adult inpatients with moderate to severe LRTIs. Patients were treated intravenously for 7 − 10 days. The treatment groups were comparable at baseline with respect to demographic and disease characteristics. Efficacy was evaluated in 72 patients. The clinical success rate was statistically superior in patients treated with cefuroxime–sulbactam (100%) compared with patients treated with amoxicillin–clavulanic acid (88%). The bacteriological success rate was 95% and 100% for cefuroxime–sulbactam and amoxicillin–clavulanic acid, respectively, with no significant difference between treatments. Both treatments were safe and well tolerated. One patient in the cefuroxime–sulbactam group reported convulsions, which the investigator considered were probably not related to the study medication. Cefuroxime–sulbactam can be an effective alternative empirical treatment for LRTIs.

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Safety and efficacy of different drug forms of amoxicillin / clavulanic acid in treatment of lower respiratory tract infections in adults: an open prospective randomized trial

Russian Pulmonology ◽

10.18093/0869-0189-2008-0-2-73-80 ◽

2008 ◽

pp. 73-80

Author(s):

I. A. Guchev ◽

R. S. Kozlov

Keyword(s):

Respiratory Tract ◽

Randomized Trial ◽

Clavulanic Acid ◽

Clinical Efficacy ◽

Lower Respiratory Tract ◽

Respiratory Tract Infections ◽

Lower Respiratory Tract Infections ◽

Amoxicillin Clavulanic Acid ◽

The Mean ◽

Tract Infections

Amoxicillin/clavulanic acid (ACA) is one of the drugs of choice for treatment of lower respiratory tract infections (LRTI) in adults. One of the serious disadvantages of ACA is relatively high rate of gastrointestinal adverse events (AE). A new form of ACA, which is dispersable tablets Solutab, could potentially reduce the rate of AE because of more rapid and predictable absorption of clavulanic acid from intestine and improve clinical outcomes due to higher adherence to treatment. This trial was aimed to compare AE rate and clinical efficacy of the new dispersable ACA form Solutab with those of traditional ACA tabs in adult patients with non-severe LRTI. The treatment regimen comprised 500/125 mg t.i.d. during 5 to12 days. This was an open, prospective randomized trial performed at 4 clinical centres. Adults with clinically and radiologically detected non-severe community-acquired pneumonia or I or II types COPD exacerbations with purulent sputum received dispersable ACA tablets (the 1st group) or traditional coated tabs of ACA (the 2nd group) in a random proportion of 1 : 1. Clinical efficacy was evaluated with clinical signs, physical symptoms, additional laboratory and instrumental testing. The safety was assessed based on the patient's complaints and results of physical and laboratory examination in visits 2 (Day 3 or 4), 3 (Day 5 to 12), and 4 (Day 30 to 40 after taking the first dose of the drug). The trial involved 200 patients, the mean age, 32.7 ± 18.7 and 33.3 ± 18.6 yrs in the 1st and the 2nd groups, respectively. The groups were similar for history, severity, and clinical course of the disease. Clinical efficacy was 96.9 % in both groups in visit 3, 95.9 % and 96.9 % in the 1st and the 2nd group, respectively, in visit 4. The mean duration of antibacterial therapy was 7.1 ± 1.5 days in the 1st group and 7.2 ± 1.4 days in the 2nd group. AE were reported in 15 % and 31 % of the patients, respectively (p = 0.01). Gastrointestinal AE predominated in both the groups but the rate of diarrhea was lower in patients receiving dispersable ACA: 6 % vs. 17 % in the 2nd group (p = 0.027). Therefore, the new dispersable drug form of ACA has better safety profile in adult patients with non-severe LRTI compared to traditional ACA that was demonstrated by reduction in the AE, mainly diarrhea, rate. Both drug forms showed equally high clinical efficacy.

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