ClinicalTrials.gg
RecruitingNCT05350813PRODISCOUpdated Aug 11, 2026

Impact of Procalcitonin-guided Algorithm on Early Discontinuation of Antibiotic Therapy

An interventional study of Measurement of the PCT plasma levels and Usual practice based on guidelines in Bacterial Infections, sponsored by University Hospital, Toulouse. Recruiting at 8 sites in France. Open to participants aged 3 Days to 17 Years. Per ClinicalTrials.gov, last updated 2026-08-11.

Sponsored by University Hospital, Toulouse · Not applicable, Interventional, and Prevention

From the registry’s dates

  • Started May 2023; still recruiting 3 years 6 months later.
Phase
Not applicable
Study type
Interventional
Enrollment
296
Allocation
Randomized
Ages
3 Days to 17 Years
Sex
All
01

Where this study stands

Counted across the records on this site · 2026-11-12

Among 49 studies in Bacterial Infections with a site in France — 8 open to participants now, 9 under way, none of them phase 3. Bacterial Infections · France.

Planned enrollment
9th of 25
296 · median 142
Started
2023
with 1 other
No phase
12 of 49
3 open now
Registered
39th of 49
by date
Lead sponsor
2 of 49
University Hospital, Toulouse

Among the 49 studies in Bacterial Infections with a site in France, this one is the 9th largest by planned enrollment of the 25 interventional ones that give a count, is one of 2 that started in 2023, is one of 12 with no phase, and was the 39th registered.

Bacterial Infections

584 studies on the registry are indexed under Bacterial Infections; 84 are open to participants now.

Browse Bacterial Infections studies →

Open to participants now

8 of the 49 studies in Bacterial Infections with a site in France are open now. Recruiting first, the newest first:

2 more — sign in →

All 8 open studies →

A study can be open while its sites in France have not opened yet or have stopped. Only those recruiting at a site in France →

Who these studies take

Of the 56 Bacterial Infections studies recruiting now, 37 (66%) set no upper age limit and 14 (25%) stop at 75 or younger; 19 take children under 18; 6 take healthy volunteers.

This study: 3 Days to 17 Years · all sexes · no healthy volunteers.

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02

Study summary

In this randomized controlled open-label trial, conducted in 7 French Pediatric and Neonatal Intensive Care Units (ICUs), investigator team hypothesize that the use of a procalcitonin (PCT)-guided algorithm to discontinue antibiotic treatment will decrease antibiotic duration in critically ill children treated for a suspected or proven bacterial infection. Two hundred and ninety-six eligible patients will be randomly assigned in two groups: either PCT-guided or standard-of-care antibiotic discontinuation, and monitored over 28 days, until the end of their hospitalization, or up to the end of antibiotic treatment for bacterial infection recurrence occurring up to 28 days after the day of randomization.

Read the detailed description

Infections are widespread in Pediatric and Neonatal ICU, and antibiotic treatments widely used. Long courses of antibiotic treatment increase the duration of hospitalization and are associated with changes in the microbiome, emergence of multidrug resistant organisms, and antibiotic-associated adverse events. In Pediatric and Neonatal ICU, PCT has a high negative predictive value to rule out bacterial infection. Thus, in sepsis patients and patients who initially appear to have sepsis but whose final diagnosis of bacterial infection is not retained, the use of a PCT-guided algorithm may be of value to shorten antibiotic duration without increasing infection recurrences. The algorithm has provided strong evidence of efficacy and safety among critically ill adults, excluding immunocompromised patients, patients with cystic fibrosis, and infections requiring prolonged antibiotic therapy. Similar data in critically ill children are lacking. A Spanish team from Sant Joan de Déu published three prospective non-randomized studies in Pediatric ICU (PICU), with encouraging results. Only one American randomized controlled trial (RCT) has been published in PICU with mixed results. One RCT is ongoing in India. Thus, our study will be the first French RCT to study the use of a PCT-guided algorithm to de-escalate antibiotic therapy in PICU, in order to provide evidence of efficacy and safety of such an algorithm in critically ill children with a suspected or proven bacterial infection. In addition, investigator team will also study the economic impact of a PCT-guided algorithm which has never been done before.

In the PCT-guided arm, PCT dosage will be done at Day 0 (day of randomization) and Day 1, and then every 48 hours until cessation of antibiotics in hospital or discharge from hospital if the patient is discharged with an antibiotic treatment. Antibiotic treatment will be stopped according to PCT value and patient clinical evolution. In the control group, antibiotic duration will be determined by usual practices based on guidelines. Inpatient evaluations will be conducted every day so long as patients receives antibiotics in hospital and usual clinical, biological and/or radiological monitoring will be conducted in both groups. To monitor infection recurrence occurring up to 28 days after the day of randomization and antibiotic-related adverse events, an evaluation will be conducted at the end of hospitalization, another at Day 28 (Day 0 = day of randomization), and a last at the end of antibiotic treatment bacterial infection recurrence, if the patient is discharged from hospital on or before Day 28 and is still treated with antibiotics for a bacterial infection recurrence at Day 28, or if the patient is discharged from hospital after Day 28 and is still treated for recurrence on the last day of hospitalization with antibiotics for a bacterial infection recurrence.

03

Conditions studied

  • Bacterial Infections

Browse trials for

Keywords

  • procalcitonin
  • Children
  • Pediatric Intensive Care Unit
  • Procalcitonin-guided antibiotic therapy
  • Algorithm
04

Who can participate

Ages eligible
3 Days to 17 Years
Sexes eligible
All
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  • Neonates, infants and children hospitalized in Pediatric and Neonatal ICU and receiving intravenous antibiotics for less than 24 hours for an episode of suspected or proven community-acquired or nosocomial bacterial infection.
  • Written signed by both parents or legal guardians.
  • Affiliated to a social security scheme.
  • Parents French-speaking.

Exclusion criteria

Exclusion Criteria:

  • Newborns \<72 hours old.
  • Neonates \<37 weeks postmenstrual age.
  • Age ≥18 years.
  • Pregnant or breastfeeding women.
  • Patients with cystic fibrosis.
  • patients including patients with hereditary immunodeficiency, agranulocytosis (neutrophils count \<500/mm3), infection with \<200/mm3, sickle cell disease, those who have undergone splenectomy, those who have a history of solid organ or hematopoietic stem cell transplant, those with hemopathy or solid organ tumor treated with chemotherapy, and those on immunosuppressive drugs including systemic taken daily for at least 15 days prior to Day 0.
  • Inflammatory situations increasing PCT plasma concentrations in the absence of infection: burns, extracorporeal membrane oxygenation (ECMO), first 48 hours following an open-heart cardiac surgery with cardiopulmonary bypass.
  • Infections requiring prolonged antibiotic therapy: infected thrombophlebitis, infective endocarditis, mediastinitis, abscess or empyema (e.g. peritonsillar abscess, retropharyngeal abscess, adenophlegmon, retroauricular abscess, retroorbital abscess, pulmonary abscess, pleural empyema, liver abscess, splenic abscess, brain abscess, subdural empyema, extradural empyema, epidural abscess, intramuscular abscess), necrotizing dermohypodermitis or necrotizing fasciitis, osteomyelitis, osteitis, arthritis, spondylodiscitis, prostatitis, tuberculosis, meningitis except those caused by Haemophilus and Meningococcus, infection on a device excluding intravascular catheter, endotracheal tube, tracheostomy, and urinary catheter.
  • Antibiotic for prophylaxis.
  • Children previously included in an interventional study in progress.
Terms in these criteria, in plain language(5)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Informed consent

Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.

You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.

Immunosuppression

A weakened immune system. It can come from an illness, such as HIV or some blood cancers, or from medicines that turn the immune system down, for example after an organ transplant or for an autoimmune disease; steroids at higher doses count.

Read whether the line is about a condition or about medicines, and which medicines and doses it means.

HIV

The human immunodeficiency virus, which weakens the immune system.

Many studies now accept people whose HIV is controlled on treatment, judged by the viral load and the CD4 count. Check the limits this study sets.

CD4 count

The number of CD4 cells, a type of white blood cell, in a given amount of blood. It is used to follow how well the immune system is doing in HIV.

Corticosteroids (steroids)

Anti-inflammatory medicines such as prednisone, prednisolone and dexamethasone — not the anabolic steroids used for muscle.

Studies differ in what they allow: check which steroid medicines, routes (tablets, injections, creams, inhalers, eye drops) and doses this study accepts.

05

Study design

Phase
Not applicable
Primary purpose
Prevention
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
296 participants (estimated)

Study arms

  • Experimental
    PCT-guided arm

    Group of patients whose duration of antibiotic therapy will depend on procalcitonin (PCT) plasma levels on days 0 and 1, then on PCT plasma level every 48 hours and on patient clinical evolution evaluated by the fever, the infected organ, and the pSOFA (Pediatric Sequential Organ Failure Assessment) score every day until cessation of antibiotics in hospital or until discharge from hospital if the patient is discharged with an antibiotic treatment.

    Procedure: Measurement of the PCT plasma levels

  • Active comparator
    standard-of-care arm

    A group of patients whose duration of antibiotic therapy will be determined by the type of infection, microbiological findings and clinical, biological and/or radiological course, according to standard practice based on guidelines.

    Procedure: Usual practice based on guidelines

Interventions

  • ProcedureMeasurement of the PCT plasma levels

    antibiotic treatment duration will be based on PCT plasma levels

  • ProcedureUsual practice based on guidelines

    antibiotic therapy duration will be determined by the type of infection, microbiological results and clinical, biological and/or radiological evolution, according to the usual practice based on guidelines.

06

What researchers measure

Primary outcomes

  1. Total duration of antibiotic therapy (in days) for a suspected or proven bacterial infection, including the first episode and recurrences occurring within 28 days following the day of randomization

    Duration of antibiotic therapy (in days) including the length of treatment for recurrences occurring within 28 days following the day of randomization. The duration of antibiotic therapy for the first episode of suspected or proven bacterial infection is the time interval, expressed in days, between the starting time of intravenous antibiotics and the stopping time of the antibiotic therapy (intravenous, intramuscular or oral). The duration of antibiotic therapy for a recurrence of bacterial infection is the time interval, expressed in days, between the starting time of a new antimicrobial therapy (intravenous, intramuscular or oral) covering the initial causative bacteria within 28 days following the day of randomization, and the stopping time of this antibiotic therapy (even if ending after 28 days following the day of randomization).

    Time frame: month 3 (maximum follow-up period of 3 months)

Secondary outcomes

  1. Total duration of broad-spectrum antibiotic therapy in days) for a suspected or proven bacterial infection, including the first episode and recurrences

    Duration of broad-spectrum antibiotic therapy (in days) including the length of treatment for recurrences occurring within 28 days following the day of randomization, and also the length of treatment for recurrences occurring within 28 days following the day of randomization. To identify broad-spectrum antibiotics, we used separately two definitions. Based on the historical definition, broad-spectrum antibiotics were all antibiotics except those with a useful activity against only Gram-positive bacteria (penicillin G, oxacillin, vancomycin, teicoplanin, linezolid, macrolides, clindamycin) and those whose main activity is against Gram-positive bacteria (amoxicillin, 1st generation cephalosporin \[cefazolin, cephalexin\], 2nd generation cephalosporin \[cefuroxime, cefaclor, cefamandole\], rifampicin).

    Time frame: month 3 (maximum follow-up period of 3 months)

  2. Length of Intensive Care Unit stay (in days) from Day 0 (day of randomization)

    Length of Intensive Care Unit stay (in days) from Day 0 (day of randomization)

    Time frame: month 3 (maximum follow-up period of 3 months)

  3. Length of hospital stay from Day 0 (day of randomization)

    Length of hospital stay from Day 0 (day of randomization)

    Time frame: month 3 (maximum follow-up period of 3 months)

  4. Recurrence of bacterial infection within 28 days following the day of randomization

    Proportion of children with recurrence of bacterial infection within 28 days following the day of randomization. The recurrence of bacterial infection is defined as the isolation of one or more of the initial causative bacteria from the same or another site at 48 hours or more after cessation of antibiotics, combined with clinical signs or symptoms of infection, or the need to prescribe a new antimicrobial therapy covering this pathogen. All recurrences of bacterial infection occurring up to Day 28, and treated in hospital (same hospital stay as for the first episode, or new hospital stay) or in ambulatory care, will be taken into account.

    Time frame: day 28

  5. All cause mortality at Day 28 (Day 0 = day of randomization)

    All cause mortality rate at Day 28 (Day 0 = day of randomization). All-cause mortality is a measure of all deaths, due to any cause, that occur during a clinical study.

    Time frame: day 28

  6. All cause mortality at the end of antibiotic treatment for bacterial infection recurrence (if ending after Day 28)

    All cause mortality rate at the end of antibiotic treatment for bacterial infection recurrence (if ending after Day 28). All-cause mortality is a measure of all deaths, due to any cause, that occur during a clinical study.

    Time frame: month 3 (maximum follow-up period of 3 months)

  7. Sepsis-related mortality at Day 28 (Day 0 = day of randomization)

    Sepsis-related mortality rate at Day 28 (Day 0 = day of randomization). Sepsis-related mortality is a measure of all deaths related to the first bacterial infection episode or bacterial infection recurrence, that occur during the study.

    Time frame: day 28

  8. Sepsis-related mortality at the end of antibiotic treatment for bacterial infection recurrence (if ending after Day 28).

    Sepsis-related mortality rate at the end of antibiotic treatment for bacterial infection recurrence (if ending after Day 28). Sepsis-related mortality is a measure of all deaths related to the first bacterial infection episode or bacterial infection recurrence, that occur during the study.

    Time frame: month 3 (maximum follow-up period of 3 months)

  9. Antibiotic-related adverse events

    Antibiotic-related adverse events

    Time frame: month 3 (maximum follow-up period of 3 months)

  10. Adherence to the PCT-guided algorithm

    This outcome will be evaluated by a stop of antibiotics within 24 hours after reaching stopping criteria : - Before Day 3: PCT levels at Day 0 and Day 1 less than 0.5 ng/mL.; - Starting Day 3: PCT level less than 0.5 ng/mL or down by ≥80% from the peak value since Day 0 AND favorable patient clinical course (defined by a decrease in pSOFA score compared to maximal value at Day 0 or Day 1, a reduction of fever and an improvement of the infected organ). - Or if the antibiotic duration, as defined by current infectious guidelines, is reached and the patient shows a favorable course, even if PCT is still ≥0.5 ng/mL or \>20% of the peak value.

    Time frame: month 3 (maximum follow-up period of 3 months)

  11. Incremental cost-effectiveness ratios

    This outcome will be expressed in terms of hospital costs per number of patients without recurrent bacterial infection at 3 months and hospital costs per number of patients alive at 3 months

    Time frame: month 3

  12. Costs of antibiotic therapy and PCT testing during each inpatient stay

    Costs of antibiotic therapy and PCT testing during each inpatient stay

    Time frame: month 3

07

Study locations

4 of 8 sites recruiting
08

References and documents

Individual participant data

Plan to share: No

No publications or documents are linked to this record.

09

Timeline

Tracking since Sep 25, 2026
ElapsedEstimatedEstimated, not yet reachedSimilar studies: half by the dot; the band is the middle halfHalf of similar studies reached it by the dot; the band is the middle half, from a quarter to three quarters

Started May 2023 (actual). Primary completion is estimated for Feb 2027, 45 months after the start.

Of 56 non-industry interventional studies with no phase under Bacterial Infections, half reached primary completion within 25 months of starting (the median), counting those still running; a quarter within 11 and three quarters within 43. This study's planned 45 months is above that.

Counting every sponsor, half of 60 studies reached it within 25 months; a quarter within 11 and three quarters within 43.

How these figures are worked out, and which studies are left out of them.

Registered
Apr 15, 2022
First posted
Apr 28, 2022
StartActual
May 2, 2023
Primary completionEst.
Feb 2, 2027
CompletionEst.
Feb 2, 2027
Last update
Aug 11, 2026
What these dates mean
Start.
When the first participant enrolled; while estimated, when the study expects to open to recruitment.
Primary completion.
When the last participant was examined or treated to collect data for the study's main question, its primary outcome. A study that stopped early gives the date its data collection stopped.
Completion.
When the last participant's last visit took place, for every outcome, secondary ones and side effects included: the end of the study. Often later than primary completion, sometimes the same day.
Actual and Est.
Actual means the registry says the date has happened. Est. (estimated) is a date the sponsor plans or expects. It can still move, and the sponsor is expected to change it to actual once it has passed.
No changes since tracking began. The registry record was last updated on Aug 11, 2026, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT05350813
Responsible party
Sponsor
First posted
Apr 28, 2022
Start date
May 2, 2023
Primary completion
Feb 2, 2027 (estimated)
Completion
Feb 2, 2027 (estimated)
Last update
Aug 11, 2026

Study contacts

Montserrat SIERRA COLOMINA, MD
Contact
sierracolomina.m@chu-toulouse.fr
05 61 74 51 45 ext. +33
Gwennaëlle ALPHONSA, MD-PH
Contact
alphonsa.g@chu-toulouse.fr
056-777-1394
Montserrat SIERRA COLOMINA, MD
principal investigator · University Hospital of Toulouse

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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