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

Background: Acute Exacerbations of COPD (AECOPD) are frequently treated with antibiotics in primary care, leading to antibiotic resistance and adverse effects. Biomarkers might assist in reducing unnecessary antibiotic prescribing when used alongside clinical assessment. Aim: To evaluate the benefit in primary care of biomarkers point-of-care testing (POCT) in practices and laboratory blood tests in decreasing antibiotic prescribing for AECOPD. Design and Setting: This systematic review identified randomised controlled trials (RCTs) and non-randomised studies conducted in primary care settings, assessing POCTs for 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. We conducted searches from January 2022 until November 2025 in four medical databases, six registers and COPD academic societies, extracted data and assessed for quality and bias. Then we performed a meta-analysis whenever possible. Results: We included seven studies. For CRP POCT, there was one RCT, four non-randomised studies and for PCT in laboratories, two RCTs. The meta-analysis of CRP POCT indicated a significant reduction in antibiotic prescribing (OR=0.41; 95% CI: [0.32-0.53]; I²=36%) and low certainty of evidence. No meta-analysis for PCT was feasible. Conclusion: CRP POCT reduces antibiotic prescribing for AECOPD in primary care settings when used alongside with clinical assessment. There is insufficient data to draw conclusions about the PCT biomarker.