Introduction of a PCT-based algorithm to guide antibiotic prescription in COPD exacerbation

Procalcitonin for Antibiotic Prescription in Chronic Obstructive Pulmonary Disease Exacerbations: Systematic Review, Meta-Analysis, and Clinical Perspective

“…A total of 14 studies were included in the metaanalysis of PCT as a biomarker for COPD exacerbation ( Fig. 1) [6,[13][14][15][16][17][18][19][20][21][22][23][24][25]. Reasons for excluding studies are summarized in Supplementary Appendix 2; the most common reason for excluding a study was the lack of reported data specifically on COPD exacerbation.…”

“…Daubin et al and Stolz et al used lower PCT level cutoffs (0.1 and 0.1-0.25 lgÁL -1 , respectively) [6,20]. An important finding among these studies is that more than three-fourths of patients had PCT blood levels below the 0.25 lgÁL -1 threshold recommended by the FDA for antibiotic prescription [13,18,20]. There was a wide variance in mean PCT blood levels in COPD exacerbation ranging from 0.06 to 1.44 lgÁL -1 (Supplementary Appendix 3); some of this variation is related to higher PCT levels reported with pneumonia.…”

“…For observational studies, three studies used a before-after study design, and appropriate selection of a non-exposed group was unclear [13,18,25]. The existence of comorbidity was not comparable between exposed and non-exposed groups in one study [18]. We were unsure about the comparability between their exposed and non-exposed groups for two studies [13,25].…”

“…A total of nine RCTs [6, 14-17, 19-21, 23] and three observational studies [13,18,25] reported hospital LOS. Outcome measures of five studies were converted from median and/or interquartile [15,[19][20][21]25].…”

“…A total of seven RCTs [15-17, 19-21, 23] and two observational studies [18,25] reported treatment failure. Criteria of treatment failure in most studies included worsening symptoms, ICU admission, death, and readmission within 72 h to 30 days of admission.…”