The Role and Importance of Procalcitonin (PCT) Testing in Rational Antibiotic Prescribing and Antibiotic Stewardship Programs

Abstract

INTRODUCTION: Antibiotic resistance is a critical global health issue, primarily driven by inappropriate antibiotic prescribing. Identifying reliable biomarkers to guide antibiotic use is essential to combat this challenge. Procalcitonin (PCT) testing has emerged as a promising tool for differentiating bacterial infections from non-bacterial conditions and supporting antibiotic stewardship programs. This literature review evaluates evidence from randomized controlled trials, observational studies, and real-world clinical data to assess the clinical utility of PCT testing in guiding antibiotic prescribing decisions. RESULTS: Across randomized controlled trials and real-world studies, PCT-guided algorithms typically yielded reductions in antibiotic duration of approximately 0.9 to 3 days in large adult cohorts, with some smaller or source-specific trials reporting reductions of up to 6 days. Relative decreases in antibiotic exposure varied widely across studies (ranging from approximately 8% to > 50%). Importantly, these reductions were achieved without increases in short-term or 28-day mortality, while hospital length of stay remained largely unchanged. Studies generally indicate that PCT-guided strategies are cost-effective, primarily driven by reduced antibiotic use. However, challenges such as interpretive difficulties, false-positive and negative results, and implementation barriers remain. CONCLUSION: Incorporating PCT testing into antibiotic stewardship strategies offers a promising approach to enhance prescribing accuracy, reduce antibiotic resistance risks, and improve patient care quality. Future research should focus on refining clinical guidelines, expanding applicability across diverse patient populations, and addressing practical challenges to facilitate widespread adoption of PCT testing in routine clinical settings.