• Sofya Tokman, Philipp Schuetz, and Stephen Bent.
• Department of Internal Medicine, University of California, San Francisco, CA, USA. sofya.tokman@ucsf.edu
• Expert Rev Anti Infect Ther. 2011 Jun 1;9(6):727-35.

AbstractThe 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.

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