PCT-guided Treatment Regarding Antibiotic Use for Acute COPD Exacerbations (PRECISION)

Inclusion Criteria: COPD, according to GOLD 2018 definition Indication for hospitalization because of acute severe exacerbation of COPD, as defined by GOLD 2018 and modified Anthonisen criteria Presence of at least 2 major symptoms of the modified Anthonisen criteria (acute deterioration in sputum volume, sputum purulence and dyspnea) or the presence of 1 major 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 (with tachycardia 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 an adolescent) will NOT be excluded/are allowed to participate. Patients with Asthma/COPD overlap syndrome (with current asthma AND COPD) will NOT 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)