Someday, I'll publish another article summary that doesn't involve a conflict-of-interest skewering. I'm really not as angry as Rob Orman says I am. This article, at least, is directly relevant to the Emergency Department.
There's been significant research into biomarkers for infectious/inflammatory processes, with the goal of identifying a sufficiently sensitive assay to use as a "rule-out" for serious infection. The goal is to use such an assay to prevent the overuse of antibiotics without increasing morbidity/mortality. This is a good thing.
Procalcitonin is the latest darling of pediatrics and intensive care units. However, to call the literature "inconclusive" is a bit of an understatement – which is why I was surprised to see an article in JAMA squarely endorsing procalcitonin-guided antibiotic-initiation strategies. After all, I've previously covered negative trials in this blog (pubmed, pubmed). However, these authors seem to have intentionally narrowed their trial selection to exclude these trials – and publish no methods regarding their systematic selection of articles.
The disclosures for all three authors includes "BRAHMS/Thermofisher". Who is this, you might ask? Google points me to: http://www.procalcitonin.com – where BRAHMS/Thermofisher will sell you one of seven procalcitonin assays. JAMA, third-ranked medicine journal in Impact Factor, reduced to advertising masquerading as peer-reviewed science.
"Clinical Outcomes Associated With
Procalcitonin Algorithms to Guide Antibiotic
Therapy in Respiratory Tract Infections"http://www.ncbi.nlm.nih.gov/pubmed/23423417