A LARGE trial conducted across 15 hospitals in England and Wales has found that using a procalcitonin-guided algorithm does not significantly reduce the duration of intravenous (IV) antibiotic treatment in children with suspected or confirmed bacterial infections.
The study, known as the BATCH trial, sought to determine whether this rapid biomarker, which is specific to bacterial infections, could help shorten antibiotic use compared to the usual care, which typically relies on C-reactive protein levels.
Between June 2018–Oct 2022, the trial enrolled 1,949 children aged from 72 hours to 18 years who were expected to remain on IV antibiotics for confirmed or suspected bacterial infection for at least 48 hours. Participants were randomly assigned to either receive procalcitonin-guided therapy or continue with the standard care approach. The study’s primary endpoints included the duration of antibiotic therapy and the safety of the intervention, with safety assessed via a composite outcome.
Results showed that the median duration of IV antibiotic use was 96 hours in the procalcitonin-guided group and 99.7 hours in the usual care group, a difference that was not statistically significant. The hazard ratio for duration of antibiotic therapy between the two groups was 0.96, suggesting no meaningful reduction in treatment duration with the procalcitonin algorithm.
In terms of safety, 9% of children in both groups experienced at least one event covered by the composite safety measure. This indicated that the procalcitonin-guided approach was non-inferior to usual care, with no significant difference in adverse events between the groups.
While procalcitonin may be useful in certain clinical scenarios, its addition to antibiotic stewardship programmes does not lead to a significant reduction in antibiotic duration in paediatric patients with bacterial infections. The results highlight the importance of maintaining robust antibiotic stewardship frameworks, where such biomarkers do not yet provide additional benefits over established clinical practices.
Ada Enesco, EMJ
Reference
Waldron CA et al.; BATCH Trial Team. Procalcitonin-guided duration of antibiotic treatment in children hospitalised with confirmed or suspected bacterial infection in the UK (BATCH): a pragmatic, multicentre, open-label, two-arm, individually randomised, controlled trial. Lancet Child Adolesc Health. 2025;DOI:10.1016/S2352-4642(24)00306-7.
