Procalcitonin Guided Antibiotic Therapy in Children with Lower Respiratory Tract Infections a Systematic Review and Meta Analysis

Abstract

Introduction: Lower respiratory tract infections remain a major cause of morbidity and antibiotic exposure in children. Objective: This study aimed to evaluate the efficacy and safety of procalcitonin-guided antibiotic therapy in children with lower respiratory tract infections. Methods: Randomized controlled trials and cohort studies published up to April 15, 2025, were searched in PubMed, ScienceDirect, and the Cochrane Library. Risk of bias was assessed using the Risk of Bias 2.0 tool and the Newcastle-Ottawa Scale. Meta-analysis was performed using Review Manager 5.4, with fixed- or random-effects models selected according to heterogeneity. Sensitivity analysis was conducted using the Duval and Tweedie trim-and-fill method. Results and Discussion: Six studies involving 3,838 children were included, comprising four randomized controlled trials and two cohort studies. Procalcitonin-guided therapy significantly reduced antibiotic treatment duration by 2.16 days (95% confidence interval -3.29 to -1.03) and hospital stay by 0.44 days (95% confidence interval -0.86 to -0.01). No significant differences were observed in antibiotic prescription, hospital readmission, or antibiotic-related adverse events. Conclusions: Procalcitonin-guided antibiotic therapy was associated with shorter antibiotic treatment duration and hospital stay in children with lower respiratory tract infections, without significant differences in antibiotic prescription, readmission, or adverse events. Further studies are warranted.