Trial reportCritical care (London, England)2020
Duration of antibiotic therapy in critically ill patients: a randomized controlled trial of a clinical and C-reactive protein-based protocol versus an evidence-based best practice strategy without biomarkers.
Trial report in Critical care (London, England), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 26 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Duration of Antibiotic Therapy in Critically Ill Patients: C-reactive Protein-guided Therapy Versus Best Practice
Efficacy and Safety of a Protocol Using C-reactive Protein to Guide Antibiotic Therapy Applied Through a Digital Clinical Decision Support Tool: a Randomized Clinical Trial
Who cites it
26 citing papers in PubMed, 3 syntheses or guidelines pooled it, 44 citations in OpenAlex.
- Pooled it
- Heterogeneity of surrogate outcome measures used in critical care studies: A systematic review.Clinical trials (London, England) · 2023Pooled it
- Use of C-reactive protein to guide the antibiotic therapy in hospitalized patients: a systematic review and meta-analysis.BMC infectious diseases · 2023Pooled it
- Biomarker guided antibiotic stewardship in community acquired pneumonia: A randomized controlled trial.PloS one · 2024Trial
- Duration of antibiotic therapy: with or without biomarkers?Acute and critical care · 2026Article
- Determining the Use and Reasons for Non-De-Escalation of Empiric Carbapenem Therapy in a Private Hospital in South Africa.Antibiotics (Basel, Switzerland) · 2025Article
- Antimicrobial resistance interventions in Latin America and the Caribbean: a scoping review of reported interventions between 2018-2024.Antimicrobial resistance and infection control · 2025Article
- Evaluating antimicrobial resistance and clinical outcomes in surgical ICU using a machine learning perspective: a retrospective observational study.BMC infectious diseases · 2025Observational
- Ventilator-associated pneumonia biomarker evaluation (VIBE) study: protocol for a prospective, observational, case-cohort study.BMJ open · 2025Article
- Interplay between C-reactive protein responses and antibiotic prescribing in people with suspected infection.BMC infectious diseases · 2025Article
- The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2024.Journal of intensive care · 2025Article
- Article
- Significant drop in serum C-reactive protein in patients with solid neoplasia and bacterial infection is associated with a better prognosis and identifies candidates for short-course antibiotic therapy.BMC infectious diseases · 2024Article
- Role of biomarkers in antimicrobial stewardship: physicians' perspectives.The Korean journal of internal medicine · 2024Article
- When to Stop Antibiotics in the Critically Ill?Antibiotics (Basel, Switzerland) · 2024Review
- The Association of Procalcitonin and C-Reactive Protein with Bacterial Infections Acquired during Intensive Care Unit Stay in COVID-19 Critically Ill Patients.Antibiotics (Basel, Switzerland) · 2023Article
- Biomarkers in sepsis-looking for the Holy Grail or chasing a mirage!World journal of critical care medicine · 2023Review
- How to use biomarkers of infection or sepsis at the bedside: guide to clinicians.Intensive care medicine · 2023Review
- Current Status of Antibiotic Stewardship and the Role of Biomarkers in Antibiotic Stewardship Programs.Infection & chemotherapy · 2022Review
- C-Reactive Protein Velocity (CRPv) as a New Biomarker for the Early Detection of Acute Infection/Inflammation.International journal of molecular sciences · 2022Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
11 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundThe rational use of antibiotics is one of the main strategies to limit the development of bacterial resistance. We therefore sought to evaluate the effectiveness of a C-reactive protein-based protocol in reducing antibiotic treatment time in critically ill patients.
methodsA randomized, open-label, controlled clinical trial conducted in two intensive care units of a university hospital in Brazil. Critically ill infected adult patients were randomly allocated to (i) intervention to receive antibiotics guided by daily monitoring of CRP levels and (ii) control to receive antibiotics according to the best practices for rational use of antibiotics.
resultsOne hundred thirty patients were included in the CRP (n = 64) and control (n = 66) groups. In the intention-to-treat analysis, the median duration of antibiotic therapy for the index infectious episode was 7.0 (5.0-8.8) days in the CRP and 7.0 (7.0-11.3) days in the control (p = 0.011) groups. A significant difference in the treatment time between the two groups was identified in the curve of cumulative suspension of antibiotics, with less exposure in the CRP group only for the index infection episode (p = 0.007). In the per protocol analysis, involving 59 patients in each group, the median duration of antibiotic treatment was 6.0 (5.0-8.0) days for the CRP and 7.0 (7.0-10.0) days for the control (p = 0.011) groups. There was no between-group difference regarding the total days of antibiotic exposure and antibiotic-free days.
conclusionsDaily monitoring of CRP levels may allow early interruption of antibiotic therapy in a higher proportion of patients, without an effect on total antibiotic consumption. The clinical and microbiological relevance of this finding remains to be demonstrated. TRIAL REGISTRY: ClinicalTrials.gov Identifier: NCT02987790. Registered 09 December 2016.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.