PCT-guided Treatment Regarding Antibiotic Use for Acute COPD Exacerbations

Inclusion Criteria:

• COPD, according to GOLD 2018 definition
• Indication for hospitalization because of acute severe exacerbation of COPD, asdefined by GOLD 2018 and modified Anthonisen criteria
• Presence of at least 2 major symptoms of the modified Anthonisen criteria (acutedeterioration in sputum volume, sputum purulence and dyspnea) or the presence of 1major symptom and 1 minor symptom (coughing, wheeze, nasal discharge, sore throat,fever)
• Post-bronchodilator FEV1/FVC < 0,70 and FEV1% < 80%pred. within last 5 years
• At least 40 years
• Smokers or ex-smokers with > 10 packyears
• Written informed consent
• Start of symptoms no more than 7 days before admission

Exclusion Criteria:

• Indication for ICU and or non-invasive ventilation < 72h of admission
• Pneumonia, radiologically confirmed
• Infection at another site and/or sepsis according to the SIRS criteria (withtachycardia and tachypnea not being caused by the exacerbation)
• COPD before age 40
• Asthma, without presence of COPD.
• Patients with COPD , with or without a history of asthma (in childhood or as anadolescent) will NOT be excluded/are allowed to participate.
• Patients with Asthma/COPD overlap syndrome (with current asthma AND COPD) willNOT be excluded/are allowed to participate.
• Clinically relevant heart failure or myocardial ischemia
• Chronic use of immunosuppressants, including prednisolone (a prednisone equivalent of 10mg or less is allowed/is NOT an exclusion criterion)
• Known bronchiectasis as a primary diagnosis
• Colonisation with Pseudomonas spp. or other micro-organisms in recent cultures (last 60 days) not susceptible to amoxicillin-clavulanic acid
• Pregnancy
• Recent exacerbation (last 28 days)