Procalcitonin-Guided Antibiotic Discontinuation in Community-Acquired Pneumonia: An Updated Systematic Review

Abstract

Introduction: Community-acquired pneumonia (CAP) drives antibiotic overuse. Procalcitonin (PCT) algorithms may shorten therapy duration, but implementation hesitancy persists. This review updates evidence on safety and antibiotic days.
Methods: PRISMA-compliant review of RCTs (≥100 adults with CAP) comparing PCT-guided vs standard care. Primary outcomes: total antibiotic duration (days) and 30-day mortality. Searched: Cochrane, Embase (2020–2024). Random-effects meta-analysis.
Results: Eleven new RCTs (n=7,106) added to 9 prior trials. Pooled antibiotic duration: PCT group 5.2 days (SD 2.1) vs control 7.8 days (SD 2.9), mean difference -2.6 days (95% CI -3.2 to -2.0). Thirty-day mortality: PCT 5.9% vs control 6.1% (OR 0.97, 0.84–1.12). Treatment failure (rehospitalization or progression) did not differ (OR 1.04). Protocol adherence was >80% in only 6 studies.
Discussion: PCT guidance safely reduces antibiotics by ~2.5 days without mortality harm. The effect is larger in low-risk CAP (Pneumonia Severity Index I–III). Barriers to adherence included clinician disbelief in low PCT values and lack of real-time testing.
Conclusions: PCT algorithms effectively reduce antibiotic exposure in CAP without compromising outcomes. Implementation strategies should address logistical barriers.