Dr. Shahneela Memon is an experienced Consultant Paediatrician with over 18 years of clinical expertise in general paediatrics, neonatology, paediatric intensive care, and cardiac ICU. She has served in senior leadership roles, including five years as Head of Paediatrics at tertiary care military hospitals in Pakistan, overseeing clinical governance, postgraduate training, and multidisciplinary care. Dr. Memon holds FCPS in Paediatrics, TDRCPCH (UK), CHPE, and advanced training in Paediatric Nephrology. She is currently pursuing an MSc in Paediatrics and Child Health (Intensive Care Pathway) at University College London (UCL) and is involved in audit and research activities at Great Ormond Street Hospital, London. Her professional interests include paediatric critical care, medical education, patient safety, and research.

Title:Procalcitonin versus serial quantitative C-reactive protein for guiding antibiotic therapy in children with suspected sepsis in resource limited settings: a critically appraised topic     Abstract:Background: In children with suspected sepsis, antibiotics are often started early but many do not go on to have proven bacterial infection. In resource limited settings, clinicians therefore need tools that can support safer antibiotic review without relying on expensive or inaccessible tests.   Objective: To compare procalcitonin with serial quantitative C-reactive protein (CRP) as biomarkers for guiding antibiotic therapy in children with suspected sepsis, with particular attention to practicality in lower resource settings.   Methods: A critically appraised review of contemporary paediatric literature was undertaken using PubMed/MEDLINE, Embase, CINAHL and the Cochrane Library, supported by hand searching of reference lists. Key papers were selected for direct relevance to paediatric antibiotic decision making, serial biomarker use and low resource applicability.   Results: The direct paediatric evidence favours procalcitonin. A meta analysis of paediatric randomised trials found that procalcitonin guided care reduced antibiotic duration, while older comparative studies showed better early discrimination of bacterial sepsis than CRP. However, the BATCH trial found that procalcitonin guided care did not significantly shorten intravenous antibiotic duration in children managed within a strong stewardship system, suggesting that benefit is context dependent. Evidence for serial CRP is less direct but clinically relevant. Serial CRP trajectories have been shown to distinguish faster from poorer responders during therapy, and a recent feasibility study from Zanzibar suggested that serial CRP point of care testing can support antibiotic review in a low resource setting. CRP is less specific and slower to change, whereas procalcitonin may be falsely high in non bacterial inflammation and falsely low in very early, chronic or focal infection.   Conclusions: Procalcitonin has the stronger direct evidence base for antibiotic guidance in children, but serial quantitative CRP remains the more pragmatic option in many resource limited settings because it is cheaper, more available and easier to repeat. Neither biomarker should be used in isolation.     Keywords: paediatric sepsis; procalcitonin; C-reactive protein; antibiotic stewardship; resource-limited settings