Procalcitonin-guided antibiotic therapy in acute exacerbation of chronic obstructive pulmonary disease: An updated meta-analysis

BACKGROUND: The benefit of a procalcitonin (PCT)-guided antibiotic strategy in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) remains uncertain. OBJECTIVES: This updated meta-analysis was performed to reevaluate the therapeutic potential of PCT-guided antibiotic therapy in AECOPD. DATA SOURCES: We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov up to February 2019 to identify randomized controlled trials (RCTs) investigating the role of PCT-guided antibiotic strategies in treating adult patients with AECOPD. Relative risk (RR) or mean differences (MD) with accompanying 95% confidence intervals (CIs) were calculated with a random-effects model. RESULTS: Eight RCTs with a total of 1376 participants were included. The results suggested that a PCT-guided antibiotic strategy reduced antibiotic prescriptions (RR: 0.55; 95% CI: 0.39–0.76; P = .0003). However, antibiotic exposure duration (MD: −1.34; 95% CI: −2.83–0.16; P = .08), antibiotic use after discharge (RR: 1.61; 95% CI: 0.61–4.23; P = .34), clinical success (RR: 1.02; 95% CI: 0.96–1.08; P = .47), all-cause mortality (RR: 1.05; 95% CI: 0.72–1.55; P = .79), exacerbation at follow-up (RR: 0.97; 95% CI: 0.80–1.18; P = .78), readmission at follow-up (RR: 1.12; 95% CI: 0.82–1.53; P = .49), length of hospital stay (MD: −0.36; 95% CI: −1.36–0.64; P = .48), and adverse events (RR: 1.33; 95% CI: 0.79–2.23; P = .28) were similar in both groups. IMPLICATIONS OF KEY FINDINGS: A PCT-guided antibiotic strategy is associated with fewer antibiotic prescriptions, and has similar efficacy and safety compared with standard antibiotic therapy in AECOPD patients.