Effect of Antibiotic Duration in Acute COPD Exacerbations

Not only did adult patients hospitalized for non-severe acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and low procalcitonin concentrations not experience improved outcomes with >24 hours of antibiotic therapy, patients who did receive >24 hours of antibiotic therapy had longer lengths of stay, according to a study published in Clinical Infectious Diseases.

Researchers sought to evaluate the treatment outcomes for patients with AECOPD and low procalcitonin concentrations who received <24 hours of antibiotic therapy compared with >24 hours of antibiotic therapy, as part of an effort to avoid antimicrobial overuse in patients with COPD. Before the study began on March 1, 2015, guidelines for patients admitted for non-severe AECOPD at Allegheny General Hospital and The Western Pennsylvania Hospital in Pittsburgh, Pennsylvania, were established.

These guidelines recommended clinicians obtain a procalcitonin concentration within 24 hours and discouraged antibiotic use in patients with concentrations <0.25μg/L. Antibiotic therapy was recommended for patients with procalcitonin concentrations ≥0.25 μg/L. A repeat procalcitonin concentration was obtained between 6 and 24 hours later for patients who did not initially receive antibiotic therapy.

Of the 356 patients eventually included for analysis, 161 patients received ≤24 hours of antibiotics, and 195 patients received >24 hours of antibiotics. There was little difference between the two study arms in all-cause 30-day readmissions (15.5% ≤24 hours vs 17.4% >24 hours; P=.63), or in COPD-related 30-day readmissions (11.2% ≤24 hours vs 12.3% >24 hours; P=.74). Furthermore, patients receiving ≤24 hours of antibiotics were, on average, prescribed a lower daily dose of corticosteroids (equivalent to 101 vs 117 prednisone mg; P=.02) and had significantly shorter lengths of stay (2.8 vs 3.7 days; P<.01).

The study investigators “believe this study adds significant data to help antimicrobial stewardship programs curb antibiotic misuse for patients with AECOPD by utilizing [procalcitonin] as an objective biomarker to refrain from utilizing extended courses of antibiotics in clinically stable patients without elevated [procalcitonin] concentrations.”

Reference

Bremmer DN, Moffa MA, Ma K, et al. Acute exacerbations of chronic obstructive pulmonary disease with a low procalcitonin: impact of antibiotic therapy [published online July 2, 2018]. Clin Infect Dis. doi:10.1093/cid/ciy552