Procalcitonin level-guided treatment reduced antibiotic use in exacerbations of COPD.

M e t h o d s Design: Randomized controlled trial. Allocation: {Not concealed}†.* Blinding: Blinded (physicians and nurses assessing outcomes {and data collectors}†).* Follow-up period: 6 months. Setting: A university hospital in Basel, Switzerland. Patients: 226 patients with COPD exacerbation (a sustained worsening from the stable state beyond normal day-to-day variations and acute enough in onset to require a change in regular medication) who met postbronchodilator therapy spirometric criteria for COPD within 48 hours of emergency department admission. Exclusion criteria included a reason other than underlying COPD for presenting signs and symptoms, psychiatric comorbid conditions, immunosuppression, asthma, cystic fibrosis, or presence of infiltrates on chest radiography. Intervention: Treatment guided by procalcitonin level (n = 113) or standard therapy (n = 113). A procalcitonin level < 0.1 μg/L indicated the absence of infection, and antibiotics were discouraged; antibiotics were encouraged if the procalcitonin level was > 0.25 μg/L. In the standard-therapy group, antibiotics were prescribed according to current guidelines by the attending physician, who was unaware of patients’ procalcitonin levels. Outcomes: Total antibiotic use at the index exacerbation and at 6 months. Secondary outcomes included improvement in symptoms, need for intensive care unit stay, length of hospital stay, mortality, exacerbation rate, and lung function. Patient follow-up: 92% (mean age 70 y, 55% women) (intention-to-treat analysis).