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A new meta-analysis shows point-of-care testing reduces unnecessary antibiotics in patients experiencing COPD exacerbations, without harming outcomes.

COPD remains a major public health concern, causing over 3 million deaths globally each year. Acute exacerbations of COPD (AECOPD) frequently prompt clinicians to prescribe antibiotics, even though many exacerbations are viral rather than bacterial in origin. This widespread and often precautionary antibiotic use contributes to rising antimicrobial resistance.

Point-of-care testing (POCT), including tools like procalcitonin (PCT) and C-reactive protein (CRP), offers rapid diagnostic insight and has the potential to guide more judicious antibiotic prescribing. A recent systematic review and meta-analysis evaluated the effectiveness of POCT in reducing antibiotic exposure in patients with AECOPD without compromising clinical safety.

Antibiotic Overuse

Antibiotics are prescribed in 50–80% of AECOPD cases, but less than half of exacerbations are bacterial. Since clinical symptoms alone can be ambiguous, many providers prescribe antibiotics “just in case.” This practice, however, escalates the threat of antibiotic resistance.

“To date, it is still not clear whether POCT benefits AECOPD patients in reducing antibiotic use and how,” wrote Lianping Yang, PhD, and colleagues in the International Journal of Infectious Diseases. “Therefore, our aim was to…evaluate the effectiveness and safety of different POCTs in guiding antibiotic prescribing for the treatment of AECOPD.”

For their systematic review and meta-analysis, Dr. Yang and colleagues included 18 studies with 4,346 patients. The analysis focused on randomized controlled trials and high-quality cohort studies comparing POCT-guided care to usual care. POCT methods included PCT, CRP, molecular diagnostics, and neutrophil-lymphocyte ratio (NLR). The primary outcomes were antibiotic prescription rates and clinical outcomes, including hospitalization, ICU transfer, and mortality.

POCT Reduces Prescribing

POCT significantly reduced unnecessary antibiotic use in patients experiencing acute exacerbations of COPD. Overall, antibiotic prescriptions dropped by 16% with POCT-guided care (Risk Difference: -0.16; 95% CI: -0.22 to -0.10), with procalcitonin (PCT)-based strategies achieving the greatest reduction at 22%. C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR) testing also led to meaningful declines in prescribing, while molecular POCT showed only a modest effect.

The average duration of antibiotic treatment was reduced by 1.19 days, with molecular POCT showing the most notable impact, shortening treatment by up to 1.9 days. Importantly, these reductions in antibiotic use were not associated with any negative impact on clinical outcomes. Rates of hospitalization, adverse events, ICU admissions, mortality, and exacerbation recurrence remained comparable between the POCT and usual care groups. Furthermore, POCT that delivered results in under two hours was linked to even greater reductions in antibiotic prescribing.

The benefits of POCT were consistent across diverse healthcare settings and remained robust in sensitivity analyses.

However, the study authors noted that challenges persist. Clinician adherence to POCT guidance varied from 49% to 61%. Moreover, cost-effectiveness data remain limited, especially in outpatient and low-resource settings.

“Despite these limitations,” the researchers said, “our findings provide compelling evidence supporting the use of POCT to guide antibiotic therapy for AECOPD without adverse effects on clinical outcomes.”