The ADAPT-Sepsis research group has demonstrated that using procalcitonin (PCT) as a biomarker to guide antibiotic duration in critically ill adults with suspected sepsis can significantly reduce treatment length without increasing mortality risks.

Following similar protocols using C-reactive protein (CRP) failed to show reductions in antibiotic duration and yielded inconclusive safety outcomes.

Pressure to improve our collective antibiotic stewardship is reflected in global initiatives to address antimicrobial resistance. Overusing antibiotics in the past has accelerated resistance in their targets, causing treatments we rely on to become increasingly less effective.

For patients who need prolonged antibiotic treatment, antimicrobial resistance can dangerously affect treatment outcomes, creating an urgent need for markers that can inform clinicians when it is safe to stop treatment.

Critically ill patients with sepsis often receive lengthy antibiotic courses. With substantial and unpredictable variations in antibiotic treatment responses between individuals, clinicians simply do not know what the optimal duration of treatment should be.

Efforts to refine treatment have relied on biomarkers, the expression of certain proteins during an illness typically retrieved through a blood test. For biomarkers involved in the trial, levels of PCT and CRP are known to be associated with infection and inflammation. Used as a form of status update, biomarker levels can guide when to stop antibiotics.

Clinical trials examining biomarker-guided protocols have yielded inconsistent recommendations. Conflicting evidence, coupled with a high mortality risk in sepsis, has compelled the search for better validated, more evidence-based strategies.

In the randomized clinical trial study, “Biomarker-Guided Antibiotic Duration for Hospitalized Patients With Suspected Sepsis: The ADAPT-Sepsis Randomized Clinical Trial,” published in JAMAresearchers at 41 National Health Service intensive care units in the United Kingdom, evaluated daily biomarker (PCT or CRP) guided protocols compared with standard care among 2,760 adults.

Patients received either daily PCT-guided advice, daily CRP-guided advice, or standard care guidance without biomarker input. Each protocol was initiated within 24 hours of starting intravenous antibiotics for suspected sepsis and continuing for up to 28 days.

Results indicated a significant reduction in total antibiotic days for the PCT-guided group compared with standard care, with a mean difference of approximately 0.9 days. Noninferiority was achieved for 28-day all-cause mortality in the PCT-guided group, establishing a safe reduction in antibiotic exposure.

CRP guidance did not reduce overall antibiotic duration, and mortality outcomes were inconclusive when compared to standard care.

These findings support the incorporation of PCT-guided protocols into standard sepsis care for critically ill adults.

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