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Procalcitonin is a peptide released by human cells in response to exposure to bacterial toxins and is measurable in the serum. Procalcitonin is also downregulated in the setting of viral infection. Therefore, it is more specific than CRP or white blood cell count. Procalcitonin has been studied as a marker to determine both when to start antibiotic therapy and duration of antibiotic therapy in infection. In these trials, antibiotics were safely held or withdrawn when the procalcitonin level was normal or decreasing by a substantial amount. Systematic reviews of available literature support the use of procalcitonin to guide treatment in patients presenting with acute respiratory infections and sepsis. Antibiotic consumption is significantly reduced across different clinical settings when guided by procalcitonin levels; procalcitonin can be used effectively in these settings only when used as a point of care test.

Branche  AR  et al. Serum procalcitonin measurement and viral testing to guide antibiotic use for respiratory infections in hospitalized adults: a randomized controlled trial. J Infect Dis. 2015 Dec 1;212(11):1692–700.
[PubMed: 25910632]
de Jong  E  et al. Efficacy and safety of procalcitonin guidance in reducing the duration of antibiotic treatment in critically ill patients: a randomised, controlled, open-label trial. Lancet Infect Dis. 2016 Jul;16(7):819–27.
[PubMed: 26947523]
Huang  DT  et al; ProACT Investigators. Procalcitonin-guided use of antibiotics for lower respiratory tract infection. N Engl J Med. 2018 Jul 19;379(3):236–49.
[PubMed: 29781385]

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