Our latest meta-analysis is now available online!!
Current evidence suggests that serum procalcitonin could safely halve antibiotic administration in COPD exacerbations!
Current evidence suggests that serum procalcitonin could safely halve antibiotic administration in COPD exacerbations!
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.
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