From the Guidelines
The recommended treatment for a suspected bacterial infection with elevated procalcitonin (PCT) levels is prompt initiation of appropriate empiric antibiotic therapy, with the specific regimen tailored to the suspected site of infection, local resistance patterns, and patient factors, and guided by the principles outlined in the Surviving Sepsis Campaign guidelines 1. When PCT levels are significantly elevated (typically >0.5 ng/mL), this strongly suggests a bacterial infection requiring antimicrobial treatment.
- The antibiotic regimen should be selected based on the suspected site of infection, with options including:
- Amoxicillin-clavulanate 875/125 mg twice daily or ceftriaxone 1-2 g daily plus azithromycin 500 mg daily for 5-7 days for community-acquired pneumonia
- Trimethoprim-sulfamethoxazole 160/800 mg twice daily for 3-5 days or ciprofloxacin 500 mg twice daily for 7 days for urinary tract infections
- Piperacillin-tazobactam 4.5 g every 6 hours or meropenem 1 g every 8 hours for more severe infections or sepsis
- Blood cultures and other relevant specimens should be collected before starting antibiotics whenever possible
- PCT levels can also guide treatment duration, with therapy potentially being discontinued when levels decrease by 80% from peak or fall below 0.5 ng/mL, as suggested by the Surviving Sepsis Campaign guidelines 1
- The treatment duration should be individualized, with a suggested duration of 7 to 10 days for most serious infections associated with sepsis and septic shock, but may be shorter or longer depending on the patient's response and other factors, as outlined in the guidelines 1
From the FDA Drug Label
To reduce the development of drug-resistant bacteria and maintain the effectiveness of PIPRACIL and other antibacterial drugs, PIPRACILshould only be used to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.
The recommended treatment for a suspected bacterial infection with elevated procalcitonin (PCT) levels is to use antibiotics such as piperacillin 2 or tazobactam 3 or 3, but only if the infection is proven or strongly suspected to be caused by susceptible bacteria.
- Key considerations:
- Use antibiotics only when necessary
- Choose antibiotics based on culture and susceptibility information
- Consider local epidemiology and susceptibility patterns when selecting therapy
- Monitor patient's clinical and bacteriological progress to adjust therapy as needed.
From the Research
Recommended Treatment for Suspected Bacterial Infection with Elevated Procalcitonin (PCT) Levels
- The use of procalcitonin as a biomarker to diagnose bacterial infection and monitor treatment is supported by several clinical practice guidelines 4.
- A study published in 2022 found that using procalcitonin to guide antibiotic escalation in patients with suspected bacterial infection could be associated with a shorter length of ICU stay 5.
- The combination of vancomycin with piperacillin-tazobactam has been shown to be synergistic against methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-intermediate S. aureus (VISA) in vitro 6, 7.
- Procalcitonin-based algorithms can safely reduce antibiotic use in stable, low-risk patients with respiratory infections and in critically ill patients with suspected sepsis 8.
- The following antibiotic combinations have been studied:
- The decision to withhold or discontinue antibiotics should be guided by procalcitonin levels, with levels of <0.25 µg/L indicating that antibiotics can be withheld or stopped early in stable, low-risk patients, and levels of <0.5 µg/L or a decrease of ≥80% from peak indicating that antibiotics can be discontinued in critically ill patients 8.