An algorithm for PCT-guided antimicrobial therapy: A consensus statement by Japanese experts

Akihiro Ito, Nobuaki Shime, Seitaro Fujishima, Shigeki Fujitani, Kosaku Komiya, Philipp Schuetz

Research output: Contribution to journalArticlepeer-review

Abstract

In Japan, a national antimicrobial resistance (AMR) action plan was adopted in 2016, advocating a 20% reduction in antibiotic consumption by 2020. However, there is still room for improvement to accomplish this goal. Many randomized controlled trials have reported that procalcitonin (PCT)-guided antimicrobial therapy could help to reduce antibiotic consumption without negative health effects, specifically in acute respiratory infections. In September 2018, some experts in Europe and the USA proposed algorithms for PCT-guided antimicrobial therapy in mild to moderate infection cases outside the ICU and severe cases in the ICU (the international experts consensus). Thereafter, a group of Japanese experts, including specialists in intensive care medicine, emergency medicine, respiratory medicine and infectious diseases, created a modified version of a PCT-guided algorithm (Japanese experts consensus). This modified algorithm was adapted to better fit Japanese medical circumstances, since PCT-guided therapy is not widely used in daily clinical practice in Japan. The Japanese algorithm has three specific characteristics. First, the target patients are limited to only hospitalized ICU or non-ICU patients. Second, pneumonia due to Pseudomonas aeruginosa, Staphylococcus aureus and Legionella species are excluded. Finally, a different timing of PCT follow-up measurement was proposed to meet restrictions of the Japanese medical insurance system. The adapted algorithms has high potential to further improve the safe reduction in antibiotic consumption in Japan, while reducing the spread of AMR pathogens.

Original languageEnglish
JournalClinical Chemistry and Laboratory Medicine
DOIs
Publication statusAccepted/In press - 2022

Keywords

  • algorithm
  • antimicrobial stewardship
  • antimicrobial-resistant pathogens
  • PCT-guided therapy
  • procalcitonin

ASJC Scopus subject areas

  • Clinical Biochemistry
  • Biochemistry, medical

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