Sepsis & septic shock · Duration of antibiotic therapy
Biomarker-Guided Antibiotic Duration for Hospitalized Patients With Suspected Sepsis
| Design | Multicentre randomised clinical trial |
|---|---|
| Treatment | Daily procalcitonin-guided or C-reactive protein-guided antibiotic discontinuation protocol |
| Control | Standard care |
| Population | Hospitalised patients with suspected sepsis, mean age 60.2, 60.3% male |
| Follow-up | 28 days |
| Primary endpoint | Total antibiotic duration and 28-day all-cause mortality |
| Result | A daily procalcitonin-guided protocol significantly reduced total antibiotic duration from randomisation to day 28 compared with standard care, without evidence of harm on mortality. |
| Secondary endpoints | 28-day all-cause mortality, ICU and hospital length of stay, adverse events |
Care guided by measurement of PCT reduces antibiotic duration safely compared with standard care, but CRP does not. All-cause mortality for CRP was inconclusive.
The trial authors, in the published abstract
Biomarker-guided stopping has a long history of small positive trials and limited uptake. Whether procalcitonin adds anything to simply stopping at seven days, as BALANCE supports, is the question this design cannot answer.
Dark P, Hossain A, McAuley DF, et al. Biomarker-Guided Antibiotic Duration for Hospitalized Patients With Suspected Sepsis: The ADAPT-Sepsis Randomized Clinical Trial. JAMA 2025 Feb 25;333(8):682-693.