Thanks again to the NEJM and study authors for hosting this great discussion on an important article in our field.
One of the somewhat unique aspects of this study compared to some of the other procalcitonin work was the study population evaluated. Specifically, the authors sought to enroll patients "with a suspected lower respiratory tract infection and for whom the treating physician was uncertain about whether antibiotic therapy was indicated." These inclusion criteria obviously impacted the distribution of types of LRTIs included in the study as well as the percentage of screened patients that were ultimately enrolled. I would be interested to hear from the study authors:
1) What was the rationale for designing the study to specifically look at this subset of patients?
2) What differences in study population do you think this introduced compared to some of the other clinical trials involving procalcitonin-guided treatment?
3) In light of increasing data suggesting that procalcitonin may have more utility in guiding earlier antibiotic cessation/discontinuation in patients with indications known to require antibiotics, would you have designed the study protocol any differently if you were to repeat it or do a follow-up study?
Thanks for any thoughts or comments!
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