Clinical utility of procalcitonin in implementation of procalcitonin-guided antibiotic stewardship in the South-East Asia and India: evidence and consensus-based recommendations

ABSTRACT

Introduction

The South-East Asian (SEA) region and India are highly susceptible to antibiotic resistance, which is caused due to lack of antimicrobial stewardship (AMS) knowledge, uncontrolled use of antibiotics, and poor infection control. Nonadherence to national/local guidelines, developed to combat antimicrobial resistance, is a major concern. A virtual advisory board was conducted to understand the current AMS standards and challenges in its implementation in these regions.

Areas covered

Procalcitonin (PCT)-guided antibiotic use was discussed in various clinical conditions across initiation, management, and discontinuation stages. Most experts strongly recommended using PCT-driven antibiotic therapy among patients with lower respiratory tract infections, sepsis, and COVID-19. However, additional research is required to understand the optimal use of PCT in patients with organ transplantation and cancer patients with febrile neutropenia. Implementation of the solutions discussed in this review can help improve PCT utilization in guiding AMS in these regions and reducing challenges.

Expert opinion

Experts strongly support the inclusion of PCT in AMS. They believe that PCT in combination with other clinical data to guide antibiotic therapy may result in more personalized and precise targeted antibiotic treatment. The future of PCT in antibiotic treatment is promising and may result in effective utilization of this biomarker.

KEYWORDS:

• Antimicrobial stewardship
• COVID-19
• LRTI
• procalcitonin
• sepsis

Article highlights

• The clinical utility of PCT in guiding antibiotic therapy among patients with LRTI, sepsis, COVID-19, febrile neutropenia in cancer, and organ transplantation are discussed in this article.

• The experts strongly recommended the use of PCT; however, evidential gaps still exist in clinical scenarios like febrile neutropenia with cancer and organ transplantation.

• Moreover, challenges such as absence of set protocol, non-adherence to treatment, etc. and their plausible solutions will aid in the implementation of PCT in antimicrobial stewardship.

• Further research is warranted for the ideal use of PCT and patient care in SEA countries and India.

Declaration of interest

Andrea Lay-Hoon Kwa, Do Ngoc Son, Kapil Zirpe, Petrick Periyasamy, Rongpong Plongla, Subramanian Swaminathan, Vu Van Giap received funds from Thermo Fischer Scientific Pte Ltd to attend the advisory board meeting Anucha Apisarnthanarak has received funding for scientific advisory board meeting from Thermo Fisher Scientific Pte Ltd. Brigitte Rina Aninda Sidharta, Tonny Loho received honorarium from Abbott Laboratories Pte Ltd (Singapore) to attend the advisory board meeting.

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

The authors are thankful to Abbott Laboratories (Singapore) Pte. Ltd. and Thermo Fisher Scientific Pte. Ltd. for providing financial support to facilitate this advisory board meeting. The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication. The authors acknowledge Ms. Ankita Mistry (Turacoz Healthcare Solutions) for helping in the coverage of advisory board meetings and publication support.

Additional information

Funding

This work was supported by Abbott Laboratories (Singapore) Pte Ltd and Thermo Fisher Scientific Pte Ltd. The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.