Procalcitonin to Reduce Antibiotic Use in Pediatric Pneumonia (P-RAPP)

Community-acquired pneumonia (CAP) is one of the most common infections in children, with ~1.5 million pediatric healthcare visits for CAP annually.1 Most cases of CAP are caused by viruses in the post-pneumococcal vaccine era, particularly in young children.2 Despite this, empirical antibiotics, often broad-spectrum, are prescribed for most children.3 The reasons for antibiotic misuse for viral respiratory illness is multifactorial.4 Overlapping clinical phenotypes of lower respiratory tract infections (LRTI) and varying definitions make a definitive diagnosis of CAP challenging.5 Clinicians may perceive that it is "safer" to prescribe antibiotics because we lack accurate methods to determine which children would benefit from antibiotics. Antibiotic overuse has substantial consequences, including antibiotic-associated side effects (e.g., allergic reactions, diarrhea), alterations to the microbiome, and severe complications (e.g., C. difficile colitis, known to increase mortality risk 6-fold).6-8 Societal risks include the development of antimicrobial resistance and cost. Thus, a strategy to reduce antibiotic use for pediatric CAP would have considerable implications.