Adult Procalcitonin (PCT) – Lower Respiratory Tract Infection

(e.g. PNA, COPD exacerbation) Guideline

Initial PCT Value

PCT Value <0.1 µg/L 0.1-0.24 µg/L 0.25-0.5 µg/L >0.5 µg/L
C
L Antibiotic Use Strongly Strongly
Recommendation Discouraged Encouraged
Discouraged Encouraged
I
N
I
-Consider alternative diagnosis Repeat PCT every 2 days to consider
C -Repeat PCT in 6-12 h if abx not begun early antibiotic discontinuation
A and no clinical improvement
-Consider overruling if clinically unstable,
L immunosuppressed or high risk (PSI IV-V,
CURB>2, GOLD III/IV)

P
R
A Follow Up PCT Value
C <0.1 µg/L or drop
PCT Value 0.1-0.24 µg/L or
0.25-0.5 µg/L >0.5 µg/L
T by >90% drop by >80%

I Antibiotic Use Discontinuation Discontinuation

Discontinuation Discontinuation
C Recommendation Strongly Strongly
Encouraged Discouraged
Encouraged Discouraged
E

G Discontinue Antibiotics If PCT rising or not adequately decreasing

consider possible treatment failure/need
U for escalating coverage or further diagnostic
I evaluation

D
E
L
I
N
E

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1 Final 20180129 TH This guideline is not intended to replace a provider’s judgment, but rather to support the decision-making process,
which must be individualized for each patient’s circumstances.
 Adult Procalcitonin (PCT) – ICU Patients with Sepsis or Severe Sepsis Guideline

ANTIBIOTIC INITIATION SHOULD NOT BE DELAYED, START ANTIBIOTICS WITH SUSPECTED SEPSIS

Initial PCT Value

PCT Value <0.25 µg/L 0.25-0.49 µg/L 0.5-1 µg/L >1 µg/L
C
L Antibiotic Use Strongly Strongly
Recommendation Discouraged Encouraged
Discouraged Encouraged
I
N
I -Consider alternative diagnosis
Repeat PCT on day 2 and day 3
C -Repeat PCT in 6-12 h if abx not begun
and no clinical improvement
A -Consider overruling if clinically unstable
L or immunosuppressed

P
R
A Follow Up PCT Value
C ≥ 0.5 µg/L and
0.25-0.49 µg/L or ≥0.5 µg/L and drop
PCT Value <0.25 µg/L rising or not
drop by >80% by <80%
T decreasing
I Antibiotic Use Discontinuation Discontinuation
Discontinuation Discontinuation
C Recommendation Strongly Strongly
Encouraged Discouraged
Encouraged Discouraged
E

G Discontinue Antibiotics -A PCT value rising or not declining by at

least 10% per day is a poor prognostic
U indicator
I -Consider expanding abx coverage or
further diagnostic evaluation
D
E
L
I
N
E

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2 Final 20180129 TH This guideline is not intended to replace a provider’s judgment, but rather to support the decision-making process,
which must be individualized for each patient’s circumstances.
 Adult Procalcitonin (PCT) Guideline

CLINICAL PEARLS
1. Decisions on antibiotic use should not be based solely on PCT levels. Interpret PCT in the clinical context of the
patient.
2. PCT is a dynamic biomarker and most useful when trends are analyzed over time
3. Interpretation of procalcitonin results in pregnancy and lactation has not been extensively studied, and no clear
C recommendations can be made.
L 4. PCT elevations may be due to a non-bacterial cause:
• Massive stress/inflammatory response: Severe trauma, extensive burns, major surgery (cardiac, transplant,
I abdominal)
N  Rapid decrease (half-life 24hr) in the absence of bacterial infection
• Addisonian crisis caused by adrenal failure
I • Medullary C-cell thyroid cancers, small cell lung cancer, lymphoma
• Prolonged circulatory failure (e.g. cardiogenic, hemorrhagic, thermal shock)
C • Treatments that stimulate cytokines (eg. OKT3, anti-lymphocyte globulins, alemtuzumab, IL-2, granulocyte
A transfusion)

L
REFERENCES
1. Schuetz P, et al. Effect of procalcitonin-based guidelines vs standard guidelines on antibiotic use in lower respiratory tract
P infections. JAMA. 2009;302:1059-66.
2. Layios N, et al. Procalcitonin usefulness for the initiation of antibiotic treatment in intensive care unit patients. Crit Care
R Med. 2012;40:2304-9.
A 3. Bouadma L, et al. Use of procalcitonin to reduce patients’ exposure to antibiotics in intensive care units (PRORATA trial): a
multicenter randomized controlled trial. Lancet. 2010;375:463-74.
C 4. Kopterides P, et al. Procalcitonin-guided algorithms of antibiotic therapy in the intensive care unit: a systematic review and
meta-analysis of randomized controlled trials. Crit Care Med. 2010;38:2229-41.
T 5. de Jong, Evelien et al. Efficacy and safety of procalcitonin guidance in reducing the duration of antibiotic treatment in critically ill
patients: a randomized, controlled, open-label trial. The Lancet Infectious Diseases, 2016; 16 (7): 819 – 827
I 6. Chu DC, et al. Practice patterns and outcomes associated with procalcitonin use in critically ill patients with sepsis. CID 2017:64.
C
E

G
U
I
D
E
L
I
N
E

Page
3 Final 20180129 TH This guideline is not intended to replace a provider’s judgment, but rather to support the decision-making process,
which must be individualized for each patient’s circumstances.