[Biomarker guided antibiotic stewardship in community acquired pneumonia].

Objective: To investigate whether the duration of antibiotic therapy in patients with CAP can be reduced using a biomarker-guided algorithm.

Design: Randomized controlled multicentre study.

Method: A total of 468 non-ICU patients with CAP were randomized after 2-3 days into three groups (ratio 1:1:1): standard treatment, PCT-guided treatment, and CRP-guided treatment. The primary outcome was the total number of days on antibiotic treatment until day 30. Secondary outcomes included new antibiotic prescriptions, time to clinical stability, length of hospital stay, and 30-day mortality.

Results: The mean age of 468 participants was 67 years, and a potential pathogen was identified in 64% of cases. The total number of days on antibiotic treatment was reduced by 30% in the CRP group (4 vs. 7 days; p < 0.001) and by 22% in the PCT group (5.5 vs. 7 days; p < 0.001). No significant differences were observed in secondary outcomes between the standard treatment and biomarker-guided treatment groups.

Conclusion: Both CRP- and PCT-guided algorithms reduce the duration of antibiotic use in non-ICU patients with CAP. No differences were observed between the three groups in terms of additional antibiotic prescriptions, length of hospital stay, or mortality.