Abstract
Challenges in the differentiation of the aetiology of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) have led to significant overuse of antibiotics. Serum procalcitonin, released in response to bacterial infections, but not viral infections, could possibly identify AECOPD requiring antibiotics. In this meta-analysis we assessed the clinical effectiveness of procalcitonin-based protocols to initiate or discontinue antibiotics in patients presenting with AECOPD.
Based on a prospectively registered protocol, we reviewed the literature and selected randomised or quasi-randomised trials comparing procalcitonin-based protocols to initiate or discontinue antibiotics versus standard care in AECOPD. We followed Cochrane and GRADE (Grading of Recommendations, Assessment, Development and Evaluation) guidance to assess risk of bias, quality of evidence and to perform meta-analyses.
We included eight trials evaluating 1062 patients with AECOPD. Procalcitonin-based protocols decreased antibiotic prescription (relative risk (RR) 0.56, 95% CI 0.43–0.73) and total antibiotic exposure (mean difference (MD) −3.83, 95% CI (−4.32–−3.35)), without affecting clinical outcomes such as rate of treatment failure (RR 0.81, 0.62–1.06), length of hospitalisation (MD −0.76, −1.95–0.43), exacerbation recurrence rate (RR 0.96, 0.69–1.35) or mortality (RR 0.99, 0.58–1.69). However, the quality of the available evidence is low to moderate, because of methodological limitations and small overall study population.
Procalcitonin-based protocols appear to be clinically effective; however, confirmatory trials with rigorous methodology are required.
Abstract
Current evidence suggests that serum procalcitonin could safely halve antibiotic administration in COPD exacerbations http://ow.ly/c693304JkYB
Footnotes
This article has supplementary material available from err.ersjournals.com
Support statement: A.G. Mathioudakis was funded by a Fellowship in Guidelines Methodology by the European Respiratory Society (MTF 2015-01). Funding information for this article has been deposited with the Open Funder Registry.
Conflict of interest: Disclosures can be found alongside this article at err.ersjournals.com
Provenance: Submitted article, peer reviewed.
- Received August 4, 2016.
- Accepted September 26, 2016.
- Copyright ©ERS 2017.
ERR articles are open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.