Abstract
Background: The rational use of antibiotics is one of the main strategies to limit the development of bacterial resistance . We therefore sought to evaluate the effectiveness of a C reactive protein-based protocol in reducing antibiotic treatment time in critically ill patients.Methods: A randomized, open-label, controlled clinical trial conducted in two intensive care units of a university hospital in Brazil. Critically ill infected adult patients were randomly allocated to: i) intervention to receive antibiotics guided by daily monitoring of CRP levels, and ii) control to receive antibiotics according to the best practices for rational use of antibiotics.Results : 130 patients were included in the CRP (n=64) and control (n=66) groups. In the intention to treat analysis, the median duration of antibiotic therapy for the index infectious episode was 7.0 (5.0-8.8) days in the CRP and 7.0 (7.0-11.3) days in the control (p = 0.011) groups. A significant difference in the treatment time between the two groups was identified in the curve of cumulative suspension of antibiotics, with less exposure in the CRP group (p = 0.007). In the per protocol analysis, involving 59 patients in each group, the median duration of antibiotic treatment was 6.0 (5.0-8.0) days for the CRP and 7.0 (7.0- 10.0) days for the control (p = 0.011) groups. Conclusions: Daily monitoring of CRP levels may aid in the reduction of antibiotic treatment time of critically ill patients, even in a scenario of judicious use of antimicrobials. Trial Registry : ClinicalTrials.gov Identifier: NCT02987790. Registered 09 December 2016, https://clinicaltrials.gov/ct2/show/NCT02987790 .
Duration of antibiotic therapy in critically ill patients: a randomized controlled trial of a C-reactive protein-based protocol versus an evidence-based best practice strategy without biomarkers