Point-of-care biomarkers or laboratory-based tests to reduce antibiotic prescribing for COPD exacerbations: a literature review and meta-analysis in primary care.

Abstract (English)

BACKGROUND: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are frequently treated with antibiotics in primary care, leading to antibiotic resistance and adverse effects. Assessing biomarkers might assist in reducing unnecessary antibiotic prescribing when used alongside clinical assessment. AIM: To evaluate the benefit of reviewing biomarkers in point-of-care testing (POCT) within practices and through laboratory blood tests in efforts to decrease antibiotic prescribing for AECOPD. DESIGN AND SETTING: Systematic review of randomised controlled trials (RCTs) and non-randomised studies conducted in primary care from January 2022 to November 2025 assessing POCTs for chronic obstructive pulmonary disease (COPD). METHOD: The primary outcome was the rate of antibiotic prescribing or use, and secondary outcomes were biomarker thresholds for prescribing antibiotics and patient harm. Searches were conducted in four medical databases, six registers, and COPD academic societies. Data were extracted and assessed for quality and bias. A meta-analysis was performed whenever possible. RESULTS: A total of seven studies were included: one RCT and four non-randomised studies for C-reactive protein (CRP) POCT; and two RCTs on procalcitonin (PCT) in laboratories. The meta-analysis of CRP POCT indicated a statistically significant reduction in antibiotic prescribing (odds ratio 0.41, 95% confidence interval = 0.32 to 0.53; <i>I</i>&#xb2; = 36%; low certainty of evidence). No meta-analysis for PCT was feasible. CONCLUSION: CRP POCT reduced antibiotic prescribing for AECOPD in primary care settings when used alongside clinical assessment. There were insufficient data to draw conclusions about the PCT biomarker.