***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: CONTEXT In previous smaller trials , a procalcitonin ( PCT ) algorithm reduced antibiotic use in patients with lower respiratory tract infections ( LRTIs ) . OBJECTIVE To examine whether a PCT algorithm can reduce antibiotic exposure without increasing the risk for serious adverse outcomes . DESIGN , SETTING , AND PATIENTS A multicenter , noninferiority , r and omized controlled trial in emergency departments of 6 tertiary care hospitals in Switzerl and with an open intervention of 1359 patients with mostly severe LRTIs r and omized between October 2006 and March 2008 . INTERVENTION Patients were r and omized to administration of antibiotics based on a PCT algorithm with predefined cutoff ranges for initiating or stopping antibiotics ( PCT group ) or according to st and ard guidelines ( control group ) . Serum PCT  was measured locally in each hospital and instructions were Web-based . MAIN OUTCOME MEASURES Noninferiority of the composite adverse outcomes of death , intensive care unit admission , disease-specific complications , or recurrent infection requiring antibiotic treatment within 30 days , with a predefined noninferiority boundary of 7.5 % ; and antibiotic exposure and adverse effects from antibiotics . RESULTS The rate of overall adverse outcomes was similar in the PCT and control groups ( 15.4 % [ n = 103 ] vs 18.9 % [ n = 130 ] ; difference , -3.5 % ; 95 % CI , -7.6 % to 0.4 % ) . The mean duration of antibiotics exposure in the PCT vs control groups was lower in all patients ( 5.7 vs 8.7 days ; relative change , -34.8 % ; 95 % CI , -40.3 % to -28.7 % ) and in the subgroups of patients with community-acquired pneumonia ( n = 925 , 7.2 vs 10.7 days ; -32.4 % ; 95 % CI , -37.6 % to -26.9 % ) , exacerbation of chronic obstructive pulmonary disease ( n = 228 , 2.5 vs 5.1 days ; -50.4 % ; 95 % CI , -64.0 % to -34.0 % ) , and acute bronchitis ( n = 151 , 1.0 vs 2.8 days ; -65.0 % ; 95 % CI , -84.7 % to -37.5 % ) . Antibiotic-associated adverse effects were less frequent in the PCT group ( 19.8 % [ n = 133 ] vs 28.1 % [ n = 193 ] ; difference , -8.2 % ; 95 % CI , -12.7 % to -3.7 % ) . CONCLUSION In patients with LRTIs , a strategy of PCT guidance compared with st and ard guidelines result ed in similar rates of adverse outcomes , as well as lower rates of antibiotic exposure and antibiotic-associated adverse effects . TRIAL REGISTRATION is rct n.org Identifier : IS RCT N95122877 Introduction Costs are one of the factors determining physicians ' choice of medication to treat patients in specific situations . However , usually only the drug acquisition costs are taken into account , whereas other factors such as the use of disposable material s , the drug preparation time and the staff workload are insufficiently taken into consideration . We therefore decided to assess true overall costs of intravenous ( IV ) antibiotic administration by performing an activity-based costing approach . Methods A prospect i ve survey on costs and workload by means of a time and motion analysis and activity-based costing was performed in a 605-bed secondary referral centre with 20 intensive care unit beds . The subjects were 50 consecutive patients admitted to our hospital with community-acquired pneumonia or intra-abdominal infections requiring treatment with IV antibiotics .  A time and motion analysis of 103 routine acts of preparing and administering IV antibiotics was performed in the intensive care unit and in the Department of Internal Medicine . To measure the entire process an inventory and work flowchart were made using detailed question naires completed by members of the nursing staff , the medical staff and the pharmacy staff . In addition , question naires were distributed to management and secretarial staff to determine additional overhead costs . The average costs for different methods of IV antibiotic administration were then compared by timing all steps in the process . Four different methods of drug administration were used : administration by volumetric pump , administration by syringe pump , administration by ' unaided ' infusion bag , and administration by direct IV injection . Results The average times required for each of these procedures , including preparation and administration of the drug , were 4:49 ± 2:37 , 4:56 ± 2:03 , 5:51 ± 3:33 and 9:21 ± 2:16 min ( mean minutes : seconds ± st and ard deviation ) , respectively . When the costs for expended staff time and material s ( not including drug costs ) were calculated this result ed in average costs of € 5.65 , € 7.28 , € 5.36 and € 3.83 , respectively , for administration of each dose of antibiotics . These costs represent between 11 % and 53 % of the total daily costs of antibiotic therapy . Compared with the acquisition costs , these indirect costs ranged from 13 % to 113 % . Not included in this comparison is the time required for insertion of an IV catheter , which was found to be 10:15 ± 6:31 min with an average calculated cost of € 9.17 . Conclusions Total costs of IV antibiotic administration are formed not only by the costs of the drugs themselves , but also , to a substantial degree , by the time expended by medical and nursing staff , costs of disposable material s and overhead costs . Physicians making decisions regarding the use of specific medications in intensive care unit patients should take these factors into account . Use of IV antibiotics is associated with considerable workload and additional costs that can exceed the acquisition costs of the medications themselves Introduction The development of resistance by bacterial species is a compelling issue to reconsider indications and administration of antibiotic treatment . Adequate indications and duration of therapy are particularly important for the use of highly potent substances in the intensive care setting . Until recently , no laboratory marker has been available to differentiate bacterial infection from viral or non-infectious inflammatory reaction ; however , over the past years , procalcitonin ( PCT ) is the first among a large array of inflammatory variables that offers this possibility . The present study aim ed to investigate the clinical usefulness of PCT for guiding antibiotic therapy in surgical intensive care patients . Methods All patients requiring antibiotic therapy based on confirmed or highly suspected bacterial infections and at least two concomitant systemic inflammatory response syndrome criteria were eligible . Patients were r and omly assigned to either a PCT-guided ( study group ) or a st and ard ( control group ) antibiotic regimen . Antibiotic therapy in the PCT-guided group was discontinued , if clinical signs and symptoms of infection improved and PCT decreased to < 1 ng/ml or the PCT value was > 1 ng/ml , but had dropped to 25 to 35 % of the initial value over three days . In the control group antibiotic treatment was applied as st and ard regimen over eight days . Results A total of 110 surgical intensive care patients receiving antibiotic therapy after confirmed or high- grade suspected infections were enrolled in this study . In 57 patients antibiotic therapy was guided by daily PCT and clinical assessment and adjusted accordingly . The control group comprised 53 patients with a st and ardized duration of antibiotic therapy over eight days . Demographic and clinical data were comparable in both groups . However , in the PCT group the duration of antibiotic therapy was significantly shorter than compared to controls ( 5.9 + /- 1.7 versus 7.9 + /- 0.5 days , P < 0.001 ) without negative effects on clinical outcome . Conclusions Monitoring of PCT is a helpful tool for guiding antibiotic treatment in surgical intensive care patients . This may contribute to an optimized antibiotic regimen with beneficial effects on microbial resistance and costs in intensive care medicine . Annotation Results were previously published in German in Anaesthesist 2008 ; 57 : 571–577 ( PMID : 18463831).Trial registration IS RCT DESIGN The objectives were to characterize the prognostic factors and evaluate the impact of inappropriate empiric antibiotic treatment and systemic response on the outcome of critically ill patients with community-acquired bloodstream infection ( BSI ) . PATIENTS A prospect i ve , multicenter , observational study was carried out in 339 patients admitted in 30 ICUs for BSI . RESULTS  Crude mortality was 41.5 % . Septic shock was present in 184 patients ( 55 % ) . The pathogens most frequently associated with septic shock or death were Escherichia coli , Staphylococcus aureus , and Streptococcus pneumoniae , which accounted for approximately half of the deaths . Antibiotic treatment was found to be inappropriate in 14.5 % of episodes . Patients in septic shock with inappropriate treatment had a survival rate below 20 % . Multivariate analysis identified a significant association between septic shock and four variables : age > or = 60 years ( odds ratio [ OR ] , 1.96 ) , previous corticosteroid therapy ( OR , 2.58 ) , leukopenia ( OR , 2.32 ) , and BSI secondary to intra-abdominal ( OR , 2.38 ) and genitourinary tract ( OR , 2.29 ) infections . The variables that independently predicted death at ICU admission were APACHE ( acute physiology and chronic health evaluation ) II score > or = 15 ( OR , 2.42 ) , development of septic shock ( OR , 3.22 ) , and inappropriate empiric antibiotic treatment ( OR , 4.11 ) . This last variable was independently associated with an unknown source of sepsis ( OR , 2.49 ) . Mortality attributable to inappropriate antibiotic treatment increased with the severity of illness at ICU admission ( 10.7 % for APACHE II score < 15 and 41.8 % for APACHE II score > or = 25 , p < 0.01 ) . CONCLUSIONS Inappropriate antimicrobial treatment  is the most important influence on outcome in patients admitted to the ICU for community-acquired BSI , particularly in presence of septic shock or high degrees of severity . Initial broad-spectrum therapy should be prescribed to septic patients in whom the source is unknown or in those requiring vasopressors Introduction Ventilator-associated pneumonia ( VAP ) is associated with increased medical re source utilization , but few r and omized studies have been conducted to evaluate the effect of initial antibiotic therapy . To assess medical re source utilization in patients with VAP , we conducted a pooled analysis of two prospect i ve , r and omized , open-label , multicenter , phase III studies , which also showed that doripenem was clinical ly noninferior to comparators . Methods We assessed duration s of mechanical ventilation , intensive care unit ( ICU ) stay , and hospitalization in patients with VAP who received at least 1 dose of doripenem or a comparator in the phase III studies . Comparators were piperacillin/tazobactam ( study 1 ) and imipenem ( study 2 ) . We analyzed between-group differences in medical re source utilization endpoints by comparison of Kaplan-Meier curves with generalized Wilcoxon test and in microbiologic eradication rates by two-sided Fisher 's exact test . Results 625 patients with VAP were evaluated and received at least 1 dose of doripenem ( n = 312 ) or a comparator ( n = 313 ) . Median duration s of mechanical ventilation ( 7 versus 10 days ; P = 0.008 ) and hospitalization ( 22 versus 26 days ; P = 0.010 ) were shorter for doripenem than comparators ; corresponding ICU stays were 12 and 13 days ( P = 0.065 ) . All-cause , overall mortality rates were similar ( 51/312 [ 16 % ] versus 47/313 [ 15 % ] ; P = 0.648 ) . MIC90 values against Pseudomonas aeruginosa for doripenem versus imipenem were 4 versus 16 μg/mL in study 2 . P. aeruginosa was eradicated from 16/24 ( 67 % ) doripenem recipients and 10/24 ( 42 % ) comparator recipients ( P = 0.147 ) . In patients with P. aeruginosa at baseline  , median duration s of mechanical ventilation ( 7 versus 13 days ; P = 0.031 ) and ICU stay ( 13 versus 21 days ; P = 0.027 ) were shorter for doripenem ; corresponding hospital stays were 24 and 35 days ( P = 0.129 ) . Conclusions Doripenem was associated with lower medical re source utilization than comparators . Differences in antipseudomonal activity may have contributed to these findings .Trial registration Clinical Trials.gov number NCT00211003 ( study 1 ) and NCT00211016 ( study 2 ) Guidelines have been developed to improve the treatment of community-acquired pneumonia ( CAP ) but information regarding their influence on costs is lacking . The aim of the present study was to conduct a cost-effect 
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to oral therapy , adjusted duration of therapy and adherence to guidelines have been found to be successful strategies .
Looking at specific antibiotics , the best evidence for cost-effectiveness is found for Linezolid in treatment of cSSTI as well as in HAP .
Daptomycin shows good economic results in bloodstream infections , so possibly being a cost-effective alternative to vancomycin .
Looking at tigecycline the published data show neither higher costs nor savings compared to imipeneme .
Doripenem as one of the newest therapy options has proven to be highly cost-saving in HAP when compared with imipenem .
However , most analyses are based on pharmacoeconomic modelling rather than on directly analysing trial data or real life clinical population s. Conclusion Using modern antibiotics in whole is not more expensive than using established therapies .
Modern antibiotics are cost-effective and sometimes even cost-saving .
This is especially true if an effective therapy is initiated as early as possible