Figure 2

Antibiotic stewardship based on procalcitonin (PCT) cut-off ranges. Re-evaluation of the clinical status and measurement of serum PCT levels is mandatory after 6–24 h in all persistently sick and hospitalized patients in who antibiotic are withheld. The PCT algorithm can be overruled by pre-specified criteria, e.g. in patients with immediately life-threatening disease. If the algorithm is overruled and antibiotics are given, an early discontinuation of antibiotic therapy after 3, 5 or 7 days is more or less endorsed based on PCT levels. In hospitalized patients with ongoing antibiotic therapy PCT levels are reassessed on days 3, 5 and 7 and antibiotics will be discontinued using the PCT cut-offs defined above. In all patients with a very high PCT value on admission (e.g., >10 μg/L), discontinuation of antibiotic is already encouraged if levels decreased below 80 to 90% of the initial value. In patients discharged and, thus, likely uncomplicated resolution of the infection or in patients transferred to an institution not taking part in this trial the recommended total duration of antibiotic therapy is based on the last PCT level and is as following: >1 ug/L 7 days, 0.5–0.99 ug/L 5 days, 0.25–0.49 ug/L 3 days, <0.25 ug/L stop antibiotic, <0.1 ug/L STOP antibiotic. PCT denotes procalcitonin, AB antibiotics,Tbc tuberculosis, ICU intensive care unit,