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Procalcitonin-Guided Antibiotics — FRCA Final MCQ

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ModerateIntensive Care MedicineProcalcitonin-Guided AntibioticsFRCA Final

A 70-year-old woman (ASA III) in ICU has septic shock with an elevated procalcitonin of 15 ng/mL. After 5 days of appropriate IV antibiotics, her clinical status has improved significantly: vasopressors stopped, temperature normal, WCC normalising. Procalcitonin has fallen to 1.2 ng/mL (>80% reduction from peak). According to current evidence, what antibiotic decision can be supported?

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Correct answer: D — Stop antibiotics guided by the procalcitonin reduction

The PRORATA and SAPS trials demonstrated that procalcitonin-guided antibiotic cessation in ICU patients reduces antibiotic exposure without increasing mortality or recurrence. SSC 2021 guidelines suggest using procalcitonin kinetics (along with clinical assessment) to guide antibiotic duration. A reduction of >80% from peak or an absolute value <0.5 ng/mL supports antibiotic cessation in clinically improving patients. This reduces unnecessary antibiotic use and antimicrobial resistance.

Reference: SSC – 2021 – International guidelines; Bouadma L et al – 2010 – PRORATA trial