What did we do?
In this study, we worked with the Manchester-based NIHR HealthTech Research Centre in Emergency and Acute Care to support the implementation of the ADAPT-Sepsis trial findings.  

 

When a critically ill adult is hospitalised with suspected sepsis, they are given antibiotics. To decide how long antibiotics are prescribed for, health professionals can assess blood biomarkers called procalcitonin (PCT) and C-reactive protein (CRP). The ADAPT-Sepsis trial tested whether using these biomarkers to guide the duration of antibiotic use was effective and safe compared with standard approaches to clinical decision making. 

 

ADAPT-Sepsis found that, compared with standard care, using PCT measurements could reduce the duration of antibiotics use in people with sepsis, without compromising their risk of mortality. Using CRP measures does not appear to reduce the duration of antibiotic delivery compared with standard care, and findings about the impact on patient mortality were inconclusive. 

 

Why was this important?

Trying to reduce the unnecessary use of antibiotics is important because of the growing risk of anti-microbial resistance. The findings of the ADAPT-Sepsis trial were important because they suggest using PCT-guided decision can reduce antibiotic use. However, we didn't know how widely this approach was used in the UK, thus whether the best treatment was provided to patients with sepsis. 

 

How did we do it?
To meet our main aim of helping to implement the findings of the ADAPT-Sepsis trial, we:

 

• completed a rapid survey of UK practice, to identify a clear research-practice gap to address. 
• drafted a rapid systematic review that brings together the ADAPT-Sepsis trial with other relevant evidence. This review ensures that decision-making is based on all relevant evidence.  

 

Events were planned to better understand barriers to implementation of research findings to consider how wider adoption of the ADAPT-Sepsis trial findings could be supported. 

 

 

Findings

The key findings from the review were:

• Evidence from 19 trials, involving 6382 patients, indicated (with moderate certainty) that procalcitonin-guided protocols probably reduced antibiotic therapy by, on average, 2.0 days compared with standard care.
• Evidence from 18 trials, involving 6228 patients, suggested (with moderate certainty) that there was an average 5% reduction in mortality risk when using procalcitonin-guided protocols compared with standard care.
• Evidence regarding C-reactive protein-guided protocols versus standard care approaches remained unclear, with very low to low certainty evidence available.

 

Resources

 

• Publications
  • Rafiq S, Shi C, Ghosal S, Dark P, Felton T, Kontopantelis E, Dumville J. (2026) Clinical effectiveness of procalcitonin- or C-reactive protein-guided antibiotic discontinuation protocols for adult patients who are critically ill with sepsis: a rapid systematic review and meta-analysis. Anaesthesia
  • Dark P, Hossain A, McAuley D, Brealey D et al. (2025) Biomarker-Guided Antibiotic Duration for Hospitalized Patients With Suspected Sepsis. The ADAPT-Sepsis Randomized Clinical Trial. JAMA
• News
  • Procalcitonin‑Guided Protocols Shorten Antibiotic Use in Sepsis (Feb 2026)
  • Test shows when safe to stop antibiotics in sepsis patients (Jan 2026)

 

Who did we work with?
•    NIHR HealthTech Research Centre in Emergency and Acute Care

 

More information
 

 

 

NIHR ARC-GM Programme Manager
Gill Rizzello
Gill.rizzello@manchester.ac.uk