A recent study highlights the potential of biomarker-guided antibiotic treatment in managing community-acquired pneumonia (CAP). The randomized controlled trial compared procalcitonin (PCT) or C-reactive protein (CRP)-guided antimicrobial treatment with standard care, focusing on the duration of antibiotic treatment. The research, led by Ruud Duijkers, MD, PhD, from the Department of Pulmonary Medicine, Northwest Hospital, Alkmaar, the Netherlands, suggests that biomarkers could streamline antibiotic prescription protocols.
Biomarker-Guided Approach
The trial screened over 1400 patients and randomized 468 across three treatment sites. While the study wasn't sufficiently powered to ascertain the safety of shorter treatments associated with biomarker-guided protocols, existing data supports the safety of PCT algorithms. Duijkers noted that many studies show physicians often overrule the PCT algorithm, especially in atypical infections where its usefulness is questioned. He emphasized the need for a safety study for the CRP algorithm before implementation to foster physician trust and reduce overruling in practice.
Challenges with Current Interventions
Duijkers pointed out the drawbacks of other interventions aimed at limiting excessive antibiotic use. Clinical stability criteria, for instance, allow antibiotic discontinuation after five days if patients recover well. However, real-world practice often sees much longer treatment durations. In the Netherlands, despite guidelines recommending five-day treatment for patients showing good clinical recovery by day three, a recent national study revealed a median treatment duration of eight days.
Antibiotic stewardship programs also face challenges. They are often costly, time-consuming, and their effects may diminish after the program ends. Rapid microbial tests, such as multiplex PCR, have been implemented to withhold antibiotics when only viral pathogens are detected. However, physicians frequently prescribe antibiotics regardless, uncertain about potential bacterial co-infections. Dr. Marc Bonten's attempt to implement a PCR identification-guided study was ultimately abandoned due to these issues.
The Promise of Biomarkers
Duijkers believes biomarkers offer an objective and easily obtainable solution. He draws a parallel to diagnosing pulmonary embolism, where biomarkers like d-dimer are integrated into clinical assessment and risk scores. Biomarkers can lead to individualized treatment protocols, moving away from a one-size-fits-all approach. "I firmly believe biomarkers can lead to individualized treatment protocols, instead of a one-size fits all approach," said Duijkers.
