Procalcitonin guided antibiotic management in lower respiratory tract infections

Lower respiratory tract infections are the most important cause of morbiditiy and mortality in all the world expecially within improving countries. We aimed to determine procalcitonine levels' relationship between diagnose and prognose by using an algorithm that arranged to PCT cut off values for hospitalized children and outpatients that diagnosed LRTI to antibiotherapy management. Our study included 195 patients with LRTI. Documents evaluated retrospectively. We determined one group with procalcitone levels cut-off 0.5 ng/dL and given antibiotherapy for LRTI. The other group with low PCT levels treated with antibiotics or not. Patients evaluated again when they went to clinics for control. It was evaluated that whether their sypmtomes and signs decreased or not. Patients' informations for diagnosis or treatment were recorded from their logs. We evaluated relationship between clinical states, recovery days that detected with physical examination; and PCT, CRP values. In our study, ages were varied between 1 to 180 months (88 female 107 male, total 195 patients included). We made comparison between patients for their demographic differences, clinic and radiologic findings. Before treatment was started, all patients' nasal PCR results are evaluated for potential factors. Viral etiologies were the most common cause in our study group. As distinct from the literature PCT cut-off value is accepted 0.5 ng/ml and patients are groupped retrospectively. It is obtained that 133 patients (% 68) was treated with antibiotics and 62 patients (% 32) was treated without any antibiotics. PCT value is found higher than 0.5 ng/ml in 60 patients (% 45) that was treated with antibiotics. PCT values were recorded at 3th day, 7th day and at the end of the treatment if they were available in our logs, because patients are groupped retrospectively as distinct from the literature. In the study it is showed that antibiotherapy lasted longer in the patients who had high PCT values than other group. It is obtained that the treatment duraation in group A was 10±3 days whereas in group B was 10±4 days. Although most of the patients' acute phase reactants' values are at lower rates, availability of clinically potential respiratory disstress leaded us to use antibiotics unnecessarily. If we had observed the patients without treating without antibiotics with considering their clinical states, they could be protected from antibiotics' side effects and prevented from unnecessarily using of antibiotics. Because of our study was retrospective, obtained results were incompatible with each other and literature. This can be explained with the absent of diagnose and treatment algorithm and the differences between every clinicians' considerations therefore it should be corrected. Using LRTI diagnose and treatment algorithms should be widely accepted and its importance should be voiced in every meetings to not only pediatric infection disease or intensitive care unit specialist but also to all pediatricians.