Antibiotic treatment of severe exacerbations of chronic obstructive pulmonary disease with procalcitonin: a randomized noninferiority trial

PloS One
Alessia VerduriFARM58J2XH Study Group

Abstract

The duration of antibiotic treatment of exacerbations of COPD (ECOPD) is controversial. Serum procalcitonin (PCT) is a biomarker of bacterial infection used to identify the cause of ECOPD. We investigated whether a PCT-guided plan would allow a shorter duration of antibiotic treatment in patients with severe ECOPD. For this multicenter, randomized, non-inferiority trial, we enrolled 184 patients hospitalized with ECOPD from 18 hospitals in Italy. Patients were assigned to receive antibiotics for 10 days (standard group) or for either 3 or 10 days (PCT group). The primary outcome was the rate of ECOPD at 6 months. Having planned to recruit 400 patients, we randomized only 183: 93 in the PCT group and 90 in the standard group. Thus, the completed study was underpowered. The ECOPD rate at 6 months between PCT-guided and standard antibiotic treatment was not significant (% difference, 4.04; 90% confidence interval [CI], -7.23 to 15.31), but the CI included the non-inferiority margin of 15. In the PCT-guided group, about 50% of patients were treated for 3 days, and there was no difference in primary or secondary outcomes compared to patients treated for 10 days. Although the primary and secondary clinical outcomes were no different ...Continue Reading

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Citations

Aug 19, 2016·Frontiers in Microbiology·Callum J CooperAnders S Nilsson
Mar 28, 2017·Respirology : Official Journal of the Asian Pacific Society of Respirology·Janice M LeungSanjay H Chotirmall
May 2, 2018·Clinical Chemistry and Laboratory Medicine : CCLM·Juliane HeyPhilipp Schuetz
Jul 10, 2018·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Derek N BremmerThomas L Walsh
Feb 2, 2017·European Respiratory Review : an Official Journal of the European Respiratory Society·Alexander G MathioudakisJørgen Vestbo
Oct 13, 2017·The Cochrane Database of Systematic Reviews·Philipp SchuetzBeat Mueller
Mar 31, 2016·Respirology : Official Journal of the Asian Pacific Society of Respirology·Fanny W KoIan A Yang

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Methods Mentioned

BETA
X-ray
ELISA

Clinical Trials Mentioned

NCT01125098

Software Mentioned

JAMA
STATA

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