{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T10:13:04Z","timestamp":1792059184610,"version":"4.4.0"},"reference-count":74,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T00:00:00Z","timestamp":1767830400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T00:00:00Z","timestamp":1767830400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100014653","name":"Manchester Biomedical Research Centre","doi-asserted-by":"publisher","award":["NIHR203308"],"award-info":[{"award-number":["NIHR203308"]}],"id":[{"id":"10.13039\/100014653","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["associationofanaesthetists-publications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Anaesthesia"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Antibiotics are a first\u2010line treatment for sepsis, with guidelines recommending a 7\u2010 to 10\u2010day course. Prolonged antibiotic use carries significant risks, prompting growing interest in using inflammatory biomarkers, such as procalcitonin or C\u2010reactive protein, to guide clinical decision\u2010making on the duration of antibiotic therapy in patients who are critically ill. This rapid systematic review aims to assess the effectiveness and safety of using procalcitonin\u2010 or C\u2010reactive protein\u2010guided protocols for antibiotic discontinuation in patients who are critically ill with sepsis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted systematic searches for articles published after January 2005 in relevant databases. Eligible studies included randomised controlled trials comparing procalcitonin\u2010 or C\u2010reactive protein\u2010guided protocols for antibiotic discontinuation with standard care, or with each other. Primary outcomes were duration of antibiotic therapy and mortality. Secondary outcomes included infection recurrences; secondary infections or superinfections; and the duration of intensive care and hospital stays.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We identified 21 eligible studies. Moderate certainty evidence from 19 trials, involving 6382 patients, indicated that procalcitonin\u2010guided protocols probably reduced antibiotic therapy by, on average, 2.0\u2009days (95%CI \u20102.6 to \u20101.4) compared with standard care. Moderate certainty evidence from 18 trials, involving 6238 patients, suggested an average 5% reduction in mortality risk when using procalcitonin\u2010guided protocols compared with standard care (risk ratio 0.95, 95%CI 0.83\u20131.07). The evidence regarding C\u2010reactive protein\u2010guided protocols versus standard care approaches remained unclear, with very low to low certainty evidence available.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Combining relevant trials suggests that procalcitonin\u2010guided discontinuation protocols may be both safe and effective for patients who are critically ill with sepsis, with no increased risk in mortality. In contrast, the evidence supporting C\u2010reactive protein\u2010guided protocols is limited. These findings underscore the potential importance of utilising procalcitonin to inform antimicrobial stewardship practices, particularly in critical care settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/anae.70109","type":"journal-article","created":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T23:00:13Z","timestamp":1767913213000},"page":"556-569","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Clinical effectiveness of procalcitonin\u2010 or C\u2010reactive protein\u2010guided antibiotic discontinuation protocols for adult patients who are critically ill with sepsis: a rapid systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"81","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4431-156X","authenticated-orcid":false,"given":"Sonya","family":"Rafiq","sequence":"first","affiliation":[{"name":"Division of Nursing, Midwifery and Social Work, Faculty of Biology, 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Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health The University of Manchester  UK"},{"name":"Critical Care Unit Northern Care Alliance NHS Foundation Trust  Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6868-6633","authenticated-orcid":false,"given":"Tim","family":"Felton","sequence":"additional","affiliation":[{"name":"Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health The University of Manchester  UK"},{"name":"Intensive Care Unit Wythenshawe Hospital, Manchester University NHS Foundation Trust  Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6450-5815","authenticated-orcid":false,"given":"Evangelos","family":"Kontopantelis","sequence":"additional","affiliation":[{"name":"Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health The University of 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