(1) To describe the existing literature on procalcitonin (PCT) as a biomarker in patients with acute rhinosinusitis (ARS), (2) to analyze outcomes in ARS patients who were treated with PCT-guided therapy versus traditional management, and (3) to compare PCT to other biomarkers used in diagnosis of bacterial ARS.
Data Sources: PubMed and Embase.
Review Methods: A systematic search in the PubMed and Embase databases was performed to identify studies related to PCT as a biomarker in ARS. After critical appraisal of validity by 2 authors, 6 studies with a total of 313 patients were selected for data extraction and analysis. We identified 2 randomized control trials (RCTs) of PCT-based guidelines for antibiotic management of ARS in outpatient settings and 4 observational studies that compared PCT to other biomarkers in patients with ARS.
Results
The 2 RCTs demonstrated a reduction (41.6% in 1 study and 71% in the other) in antibiotic prescription rate in the PCT-guided group versus the control group with no change in the number of days with impaired activity due to illness (9.0 vs 9.0 days [P = .96]; 8.1 vs 8.2 days [95% confidence interval −0.7 to 0.7]), number of days of work missed, and percentage of patients with persistent symptoms at 28 days. In the observational cohort studies, PCT did not consistently correlate with C-reactive protein, body temperature, and/or white blood cell counts.
Conclusions
The limited existing literature on the role of PCT in diagnosis, management, and prediction of clinical outcomes in ARS suggests that PCT-based guidelines for antibiotic prescription are a safe and effective method of minimizing unnecessary antibiotic use.
PynnonenMALynnSKernHEet al.
Diagnosis and treatment of acute sinusitis in the primary care setting: a retrospective cohort.Laryngoscope. 2015;
125(10):2266–2272.
2.
LeeLNBhattacharyyaN.Regional and specialty variations in the treatment of chronic rhinosinusitis.Laryngoscope. 2011;
121(5):1092–1097.
GarbuttJMBanisterCSpitznagelEPiccirilloJF.Amoxicillin for acute rhinosinusitis: a randomized controlled trial.JAMA. 2012;
307(7):685–692.
5.
LemiengreMBvan DrielMLMerensteinDYoungJDe SutterAI.Antibiotics for clinically diagnosed acute rhinosinusitis in adults.Cochrane Database Syst Rev. 2012;10:CD006089.
6.
Ahovuo-SalorantaARautakorpiUMBorisenkoOVLiiraHWilliamsJWJrMakelaM.Antibiotics for acute maxillary sinusitis in adults.Cochrane Database Syst Rev. 2014;
2:CD000243.
7.
SmithSSEvansCTTanBKChandraRKSmithSBKernRC.National burden of antibiotic use for adult rhinosinusitis.J Allergy Clin Immunol. 2013;
132(5):1230–1232.
8.
MeltzerEOHamilosDL.Rhinosinusitis diagnosis and management for the clinician: a synopsis of recent consensus guidelines.Mayo Clin Proc. 2011;
86(5):427–443.
9.
RosenfeldRMAndesDBhattacharyyaNet al.
Clinical practice guideline: adult sinusitis.Otolaryngol Head Neck Surg. 2007;
137(3 Suppl):S1–S31.
10.
FokkensWLundVMullolJ.European position paper on rhinosinusitis and nasal polyps 2007.Rhinol Suppl. 2007(20):1–136.
11.
RosenfeldRMPiccirilloJFChandrasekharSSet al.
Clinical practice guideline (update): adult sinusitis.Otolaryngol Head Neck Surg. 2015;
152(2 Suppl):S1–S39.
12.
SlavinRGSpectorSLBernsteinILet al.
The diagnosis and management of sinusitis: a practice parameter update.J Allergy Clin Immunol. 2005;
116(6 Suppl):S13–S47.
ChowAWBenningerMSBrookIet al.
IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults.Clin Infect Dis. 2012;
54(8):e72–e112.
15.
FokkensWJLundVJMullolJet al.European position paper on rhinosinusitis and nasal polyps 2012. Rhinology. 2012;
50(S23):1–307.
16.
SmithSSKernRCChandraRKTanBKEvansCT.Variations in antibiotic prescribing of acute rhinosinusitis in United States ambulatory settings.Otolaryngol Head Neck Surg. 2013;
148(5):852–859.
17.
GonzalesRSteinerJFLumABarrettPHJr.Decreasing antibiotic use in ambulatory practice: impact of a multidimensional intervention on the treatment of uncomplicated acute bronchitis in adults.JAMA. 1999;
281(16):1512–1519.
18.
SharpHJDenmanDPuumalaSLeopoldDA.Treatment of acute and chronic rhinosinusitis in the United States, 1999-2002.Arch Otolaryngol Head Neck Surg. 2007;
133(3):260–265.
19.
FairlieTShapiroDJHershALHicksLA.National trends in visit rates and antibiotic prescribing for adults with acute sinusitis.Arch Intern Med. 2012;
172(19):1513–1514.
20.
YoungJDe SutterAMerensteinDet al.
Antibiotics for adults with clinically diagnosed acute rhinosinusitis: a meta-analysis of individual patient data.Lancet2008;
371(9616):908–914.
21.
van den BroekMFGuddenCKluijfhoutWPet al.
No evidence for distinguishing bacterial from viral acute rhinosinusitis using symptom duration and purulent rhinorrhea: a systematic review of the evidence base.Otolaryngol Head Neck Surg. 2014;
150(4):533–537.
22.
MullerBBeckerKLSchachingerHet al.
Calcitonin precursors are reliable markers of sepsis in a medical intensive care unit.Crit Care Med. 2000;
28(4):977–983.
23.
LiuDSuLXGuanWXiaoKXieLX.Prognostic value of procalcitonin in pneumonia: a systematic review and meta-analysis.Respirology. 2016;
21(2):280–288.
24.
ViasusDDel Rio-PertuzGSimonettiAFet al.
Biomarkers for predicting short-term mortality in community-acquired pneumonia: a systematic review and meta-analysis.J Infect. 2016;
72(3):273–282.
25.
SchuetzPDanielsLBKulkarniPAnkerSDMuellerB.Procalcitonin: a new biomarker for the cardiologist.Int J Cardiology. 2016;
223:390–397.
26.
WhangKTVathSDBeckerKLet al.
Procalcitonin and proinflammatory cytokine interactions in sepsis.Shock. 2000;
14(1):73–78.
27.
MoherDLiberatiATetzlaffJAltmanDG.Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.J Clin Epidemiol. 2009;
62(10):1006–1012.
28.
BrielMSchuetzPMuellerBet al.
Procalcitonin-guided antibiotic use vs a standard approach for acute respiratory tract infections in primary care.Arch Intern Med. 2008;
168(18):2000–2007; discussion 2007–2008.
29.
BurkhardtOEwigSHaagenUet al.
Procalcitonin guidance and reduction of antibiotic use in acute respiratory tract infection.Eur Respir J. 2010;
36(3):601–607.
30.
MeiliMKutzABrielMet al.Infection biomarkers in primary care patients with acute respiratory tract infections-comparison of procalcitonin and C-reactive protein. BMC Pulm Med. 2016;
16:43.
31.
AutioTJKoskenkorvaTLeinoTKKoivunenPAlhoOP.Longitudinal analysis of inflammatory biomarkers during acute rhinosinusitis. Laryngoscope. 2017;
127(2):E55–E61.
32.
KofteridisDPSamonisGKaratzanisADet al.C-reactive protein and serum procalcitonin levels as markers of bacterial upper respiratory tract infections. Am J Infect Dis. 2009;
5(4):289–294.
33.
ChauhanPSoodAJainMDablaPSoodS.Serum PCT and CRP levels in upper respiratory tract infections as a marker of infection.Clin Rhinol. 2013;
6(1):1–4.
GoossensHFerechMVander SticheleRElseviersM, ESAC Project Group.
Outpatient antibiotic use in Europe and association with resistance: a cross-national database study.Lancet. 2005;
365(9459):579–587.
36.
RobertsRRHotaBAhmadIet al.
Hospital and societal costs of antimicrobial-resistant infections in a Chicago teaching hospital: implications for antibiotic stewardship.Clin Infect Dis. 2009;
49(8):1175–1184.
McDonaghMPetersonKWinthropKCantorAHolzhammerBBuckleyD.Improving Antibiotic Prescribing for Uncomplicated Acute Respiratory Tract Infections. Rockville, MD: Agency for Healthcare Research and Quality; 2016.
39.
DoolingKLShapiroDJVan BenedenCHershALHicksLA.Overprescribing and inappropriate antibiotic selection for children with pharyngitis in the United States, 1997–2010.JAMA Pediatr. 2014;
168(11):1073–1074.
40.
BarnettMLLinderJA.Antibiotic prescribing to adults with sore throat in the United States, 1997-2010.JAMA Intern Med. 2014;
174(1):138–140.
41.
ShapiroDJHicksLAPaviaATHershAL.Antibiotic prescribing for adults in ambulatory care in the USA, 2007-09.J Antimicrob Chemother. 2014;
69(1):234–240.
42.
BergmarkRWSedaghatAR.Antibiotic prescription for acute rhinosinusitis: emergency departments versus primary care providers.Laryngoscope. 2016;
126(11):2439–2444.
43.
SharpALKlauMHKeschnerDet al.
Low-value care for acute sinusitis encounters: who’s choosing wisely?Am J Manag Care. 2015;
21(7):479–485.
44.
AlbrichWCMonnetDLHarbarthS.Antibiotic selection pressure and resistance in Streptococcus pneumoniae and Streptococcus pyogenes.Emerg Infect Dis. 2004;
10(3):514–517.
45.
CalsJWButlerCCHopstakenRMHoodKDinantGJ.Effect of point of care testing for C reactive protein and training in communication skills on antibiotic use in lower respiratory tract infections: cluster randomised trial.BMJ. 2009;
338:b1374.
46.
GonzalesRCorbettKKWongSet al.
“Get smart Colorado”: impact of a mass media campaign to improve community antibiotic use.Med Care. 2008;
46(6):597–605.
47.
CevcG.Differential diagnosis and proper treatment of acute rhinosinusitis: guidance based on historical data analysis. Allergy Rhinol (Providence). 2017;
8(2):45–52.
48.
WorrallGHutchinsonJShermanGGriffithsJ.Diagnosing streptococcal sore throat in adults: randomized controlled trial of in-office aids.Can Fam Physician. 2007;
53(4):666–671.
49.
BarhamHPZhangASChristensenJMSacksRHarveyRJ.Acute radiology rarely confirms sinus disease in suspected recurrent acute rhinosinusitis.Int Forum Allergy Rhinol. 2017;
7(7):726–733.
50.
HarbarthSAlbrichWBrun-BuissonC.Outpatient antibiotic use and prevalence of antibiotic-resistant pneumococci in France and Germany: a sociocultural perspective.Emerg Infect Dis. 2002;
8(12):1460–1467.
51.
SimonLGauvinFAmreDKSaint-LouisPLacroixJ.Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis.Clin Infect Dis. 2004;
39(2):206–217.
52.
NijstenMWOlingaPTheTHet al.
Procalcitonin behaves as a fast responding acute phase protein in vivo and in vitro.Crit Care Med. 2000;
28(2):458–461.
53.
EnguixAReyCConchaAMedinaACotoDDieguezMA.Comparison of procalcitonin with C-reactive protein and serum amyloid for the early diagnosis of bacterial sepsis in critically ill neonates and children.Intensive Care Med. 2001;
27(1):211–215.
