Procalcitonin Is Not Useful to Guide Antibiotic Therapy for COPD Exacerbations in Critically Ill Patients

Procalcitonin (PCT) testing is gaining attention for its potential to decrease or de-escalate antibiotic use. Exacerbations of chronic obstructive pulmonary disease (COPD) would seem to be the ideal situation for PCT-guided antibiotic de-escalation, since about half of cases are thought to result from bacterial infection.

In a multicenter, randomized trial, these authors tested whether a strategy of antibiotic de-escalation guided by PCT is noninferior to standard therapy for COPD exacerbations. The authors enrolled 302 patients admitted to 11 intensive care units (ICUs) in France with COPD exacerbations, with or without pneumonia. Patients randomized to the PCT-guided arm had PCT levels measured five times (at enrollment, 6 hours, and days …