Procalcitonin-guided antibiotic treatment of respiratory tract infections in a primary care setting: are we there yet?

Prim Care Respir J. 2011 Dec;20(4):360-7. doi: 10.4104/pcrj.2011.00064.


Clinical signs of infection do not allow for correct identification of bacterial and viral aetiology in acute respiratory infections. A valid tool to assist the clinician in identifying patients who will benefit from antibiotic therapy, as well as patients with a potentially serious infection, could greatly improve patient care and limit excessive antibiotic prescriptions. Procalcitonin is a new marker of suspected bacterial infection that has shown promise in guiding antibiotic therapy in acute respiratory tract infections in hospitals without compromising patient safety. Procalcitonin concentrations in primary care are low and can be used primarily to rule out serious infection. However, procalcitonin measurement should not be used as the sole basis for clinical decisions; clinical skills are prerequisites for the correct use of this new tool in practice. At present there is no point-of-care test for procalcitonin with acceptable precision, severely hampering its application in primary care. This article reviews the physiology of procalcitonin, describes the assays available for its measurement, evaluates the present evidence from primary care on its use to identify correctly patients who are likely to benefit from antibiotic treatment and to rule out serious infections, and comments on further research to determine a future role for procalcitonin in primary care.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Biomarkers / blood*
  • Calcitonin Gene-Related Peptide
  • Calcitonin*
  • Humans
  • Immunoassay / methods
  • Immunoassay / standards
  • Primary Health Care
  • Protein Precursors*
  • Respiratory Tract Infections / blood*
  • Respiratory Tract Infections / diagnosis
  • Respiratory Tract Infections / drug therapy
  • Respiratory Tract Infections / microbiology*
  • Sensitivity and Specificity


  • Anti-Bacterial Agents
  • Biomarkers
  • CALCA protein, human
  • Protein Precursors
  • Calcitonin
  • Calcitonin Gene-Related Peptide