Biomarker-Guided Antibiotic Duration for Hospitalized Patients With Suspected Sepsis: The ADAPT-Sepsis Randomized Clinical Trial
An erratum to this article was published (JAMA, 13 Jan 2026 ↗)
Authors' conclusion
Care guided by measurement of PCT reduces antibiotic duration safely compared with standard care, but CRP does not. All-cause mortality for CRP was inconclusive.
Study context
- Population
- Critically ill adults (≥18 years) in 41 UK National Health Service (NHS) ICUs requiring critical care within 24 hours of starting IV antibiotics for suspected sepsis, likely to continue antibiotics ≥72 hours
- Participants
- 2,760 adults · 41 UK NHS ICUs
- Comparison
- Daily procalcitonin (PCT)-guided or daily C-reactive protein (CRP)-guided protocol vs standard care for antibiotic duration
- PCTn = 918
- CRPn = 924
- Standard caren = 918reference
- Primary endpoint
- Total duration of antibiotics (effectiveness) and all-cause mortality (safety)
- Follow-up
- Up to 28 days
Methodological detailsmulticentre, intervention-concealed, non-inferiority (mortality)
- Multicentre
- Intervention-concealed
- Non-inferiority (mortality)
Primary result
As reported in the abstract
Antibiotic duration from randomization to 28 days
Each group vs standard careMean difference, days (95% CI)P value
PCT
0.88(0.19–1.58)
P = 0.01Each group vs standard careMean difference (95% CI)P value
CRP
0.09(−0.60 to 0.79)
P = 0.79Secondary outcomes
| Outcome | PCT | CRP | Standard care | Absolute difference (95% CI) | P value | |
|---|---|---|---|---|---|---|
| All-cause mortality up to 28 days (primary safety outcome)PCT vs Standard care · noninferior; margin 5.4% | 20.9% | 21.1% | 19.4% | 1.57 (−2.18 to 5.32) | P = 0.02 | |
| All-cause mortality up to 28 days (primary safety outcome)CRP vs Standard care · inconclusive | 1.69 (−2.07 to 5.45) | P = 0.03 | ||||
| −50510Difference (linear scale) |
- All-cause mortality up to 28 days (primary safety outcome): noninferiority margin 5.4%
- All-cause mortality up to 28 days (primary safety outcome): denominators: standard care 878, PCT 879, CRP 874
Original publication
Biomarker-Guided Antibiotic Duration for Hospitalized Patients With Suspected Sepsis: The ADAPT-Sepsis Randomized Clinical Trial. JAMA. Published 25 February 2025. doi:10.
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