title: Procalcitonin-guided antibiotic therapy for chronic obstructive pulmonary disease exacerbations.
abstract: The aim of this article is to review the current literature examining the use of procalcitonin-guided antibiotic therapy for management of chronic obstructive pulmonary disease (COPD) exacerbations. Procalcitonin is a serum marker that rises in response to bacterial infections, but remains low in nonbacterial infections and other proinflammatory conditions. To date, there are four randomized clinical trials which compare procalcitonin-guided antibiotic therapy to standard therapy in patients with COPD exacerbations. In all four trials the use of procalcitonin was associated with a reduction in antibiotic use (prescription and/or duration) without an increase in the rates of adverse patient outcomes including death, admission to the intensive care unit, re-exacerbation and readmission to the hospital. This data is clinically significant and suggests that the use of procalcitonin-guided antibiotic therapy has the potential to decrease unnecessary antibiotic use in nonbacterial COPD exacerbations, thereby curtailing the spread of antibiotic-resistant bacteria, reducing antibiotic-related adverse reactions, including Clostridium difficile infection, and potentially reducing healthcare costs.
authors.affiliation: Department of Internal Medicine, University of California, San Francisco, CA, USA. sofya.tokman@ucsf.edu
authors.forename: Sofya
authors.initials: S
authors.lastname: Tokman
authors.forename: Philipp
authors.initials: P
authors.lastname: Schuetz
authors.forename: Stephen
authors.initials: S
authors.lastname: Bent
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood*; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D016360:Clostridioides difficile / Q000254:growth & development*; D018450:Disease Progression; D024881:Drug Resistance, Bacterial / Q000187:drug effects; D006801:Humans; D008168:Lung / Q000187:drug effects / Q000382:microbiology* / Q000473:pathology; D011498:Protein Precursors / Q000097:blood; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D012141:Respiratory Tract Infections / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide