Design and rationale of the Procalcitonin Antibiotic Consensus Trial (ProACT), a multicenter randomized trial of procalcitonin antibiotic guidance in lower respiratory tract infection

ProACT Investigators

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Overuse of antibiotics is a major public health problem, contributing to growing antibiotic resistance. Procalcitonin has been reported to be commonly elevated in bacterial, but not viral infection. Multiple European trials found procalcitonin-guided care reduced antibiotic use in lower respiratory tract infection, with no apparent harm. However, applicability to US practice is limited due to trial design features impractical in the US, between-country differences, and residual safety concerns. Methods: The Procalcitonin Antibiotic Consensus Trial (ProACT) is a multicenter randomized trial to determine the impact of a procalcitonin antibiotic prescribing guideline, implemented with basic reproducible strategies, in US patients with lower respiratory tract infection. Discussion: We describe the trial methods using the Consolidated Standards of Reporting Trials (CONSORT) framework, and the rationale for key design decisions, including choice of eligibility criteria, choice of control arm, and approach to guideline implementation. Trial registration: ClinicalTrials.gov NCT02130986. Registered May 1, 2014.

Original languageEnglish
Article number25
JournalBMC Emergency Medicine
Volume17
Issue number1
DOIs
Publication statusPublished - 29-08-2017

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Calcitonin
Respiratory Tract Infections
Multicenter Studies
Anti-Bacterial Agents
Guidelines
Virus Diseases
Microbial Drug Resistance
Public Health
Safety

All Science Journal Classification (ASJC) codes

  • Emergency Medicine

Cite this

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title = "Design and rationale of the Procalcitonin Antibiotic Consensus Trial (ProACT), a multicenter randomized trial of procalcitonin antibiotic guidance in lower respiratory tract infection",
abstract = "Background: Overuse of antibiotics is a major public health problem, contributing to growing antibiotic resistance. Procalcitonin has been reported to be commonly elevated in bacterial, but not viral infection. Multiple European trials found procalcitonin-guided care reduced antibiotic use in lower respiratory tract infection, with no apparent harm. However, applicability to US practice is limited due to trial design features impractical in the US, between-country differences, and residual safety concerns. Methods: The Procalcitonin Antibiotic Consensus Trial (ProACT) is a multicenter randomized trial to determine the impact of a procalcitonin antibiotic prescribing guideline, implemented with basic reproducible strategies, in US patients with lower respiratory tract infection. Discussion: We describe the trial methods using the Consolidated Standards of Reporting Trials (CONSORT) framework, and the rationale for key design decisions, including choice of eligibility criteria, choice of control arm, and approach to guideline implementation. Trial registration: ClinicalTrials.gov NCT02130986. Registered May 1, 2014.",
author = "{ProACT Investigators} and Huang, {David T.} and Angus, {Derek C.} and Chang, {Chung Chou H.} and Yohei Doi and Fine, {Michael J.} and Kellum, {John A.} and Yohei Doi and Francis Pike and Weissfeld, {Lisa A.} and Jonathan Yabes and Yealy, {Donald M.} and M. Donnino and P. Hou and R. Sherwin and J. Holst and C. Rafferty and D. Rodgers and W. Dachman and F. LoVecchio and M. Filbin and J. Hammel and M. Exline and L. Southerland and M. Kurz and D. McCullum and S. Lotfipour and G. Wilkerson and H. Prunty and B. Suffoletto and A. Brown and F. Jovin",
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T1 - Design and rationale of the Procalcitonin Antibiotic Consensus Trial (ProACT), a multicenter randomized trial of procalcitonin antibiotic guidance in lower respiratory tract infection

AU - ProACT Investigators

AU - Huang, David T.

AU - Angus, Derek C.

AU - Chang, Chung Chou H.

AU - Doi, Yohei

AU - Fine, Michael J.

AU - Kellum, John A.

AU - Doi, Yohei

AU - Pike, Francis

AU - Weissfeld, Lisa A.

AU - Yabes, Jonathan

AU - Yealy, Donald M.

AU - Donnino, M.

AU - Hou, P.

AU - Sherwin, R.

AU - Holst, J.

AU - Rafferty, C.

AU - Rodgers, D.

AU - Dachman, W.

AU - LoVecchio, F.

AU - Filbin, M.

AU - Hammel, J.

AU - Exline, M.

AU - Southerland, L.

AU - Kurz, M.

AU - McCullum, D.

AU - Lotfipour, S.

AU - Wilkerson, G.

AU - Prunty, H.

AU - Suffoletto, B.

AU - Brown, A.

AU - Jovin, F.

PY - 2017/8/29

Y1 - 2017/8/29

N2 - Background: Overuse of antibiotics is a major public health problem, contributing to growing antibiotic resistance. Procalcitonin has been reported to be commonly elevated in bacterial, but not viral infection. Multiple European trials found procalcitonin-guided care reduced antibiotic use in lower respiratory tract infection, with no apparent harm. However, applicability to US practice is limited due to trial design features impractical in the US, between-country differences, and residual safety concerns. Methods: The Procalcitonin Antibiotic Consensus Trial (ProACT) is a multicenter randomized trial to determine the impact of a procalcitonin antibiotic prescribing guideline, implemented with basic reproducible strategies, in US patients with lower respiratory tract infection. Discussion: We describe the trial methods using the Consolidated Standards of Reporting Trials (CONSORT) framework, and the rationale for key design decisions, including choice of eligibility criteria, choice of control arm, and approach to guideline implementation. Trial registration: ClinicalTrials.gov NCT02130986. Registered May 1, 2014.

AB - Background: Overuse of antibiotics is a major public health problem, contributing to growing antibiotic resistance. Procalcitonin has been reported to be commonly elevated in bacterial, but not viral infection. Multiple European trials found procalcitonin-guided care reduced antibiotic use in lower respiratory tract infection, with no apparent harm. However, applicability to US practice is limited due to trial design features impractical in the US, between-country differences, and residual safety concerns. Methods: The Procalcitonin Antibiotic Consensus Trial (ProACT) is a multicenter randomized trial to determine the impact of a procalcitonin antibiotic prescribing guideline, implemented with basic reproducible strategies, in US patients with lower respiratory tract infection. Discussion: We describe the trial methods using the Consolidated Standards of Reporting Trials (CONSORT) framework, and the rationale for key design decisions, including choice of eligibility criteria, choice of control arm, and approach to guideline implementation. Trial registration: ClinicalTrials.gov NCT02130986. Registered May 1, 2014.

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