Procalcitonin-Guided Care Reduces Antibiotic Use in Acute Pancreatitis

Antibiotics, pills
Antibiotics, pills
Researchers examined whether using a procalcitonin-based algorithm could decrease antibiotic use in patients with acute pancreatitis.

Using a procalcitonin-based algorithm for initiation, continuation, and discontinuation of antibiotics leads to reduced antibiotic use among patients with acute pancreatitis, according to study findings published in The Lancet Gastroenterology & Hepatology.

Researchers conducted a single-center, patient-blinded, randomized controlled trial, called PROCAP, to test whether procalcitonin-based care could decrease antibiotic use without adverse effects in acute pancreatitis. Of 369 patients aged 18 years and older with acute pancreatitis, researchers enrolled 260 (mean age, 50.9±16.9 years; men, 51%). Patients were randomly assigned 1:1 to either procalcitonin-based care (intervention) to guide the initiation, continuation, and cessation of antibiotics or usual care (control group).  

The procalcitonin-based care group underwent procalcitonin testing on days 0, 4, 7, and then weekly. The recommendation for patients who received a test value lower than 1.0 ng/mL was to stop or not initiate antibiotics. Patients could start or continue antibiotics after receiving a test value of 1.0 ng/mL or higher. The usual care group received standard care for acute pancreatitis per current guidelines from the International Association of Pancreatology/American Pancreatic Association.

The primary outcome was receiving treatment with antibiotics during index admission to the hospital. Index stay was defined as time from first hospital admission to discharge. Secondary outcomes included days of antibiotic use, infections, and all-cause mortality.

Overall, fewer patients in the procalcitonin-based care group were prescribed antibiotics than in the usual care group (45% vs 63%; adjusted risk difference, -15.6%; 95% CI, -27.0 to -4.2; P =.0071). The procalcitonin-based care group vs usual care group also had a significantly lower mean number of days of antibiotic use per patient. The number of clinical infections was comparable across both groups. Regarding all-cause mortality, 4 patients died in the procalcitonin-based care group vs 3 patients in the usual care group.

“The PROCAP randomized trial found that a procalcitonin algorithm reduced antibiotic use without increasing infection or harm in patients with acute pancreatitis,” the study authors wrote.

Reference

Siriwardena AK, Jegatheeswaran S, Mason JM, et al. A procalcitonin-based algorithm to guide antibiotic use in patients with acute pancreatitis (PROCAP): a single-centre, patient-blinded, randomised controlled trial. Trials. Published online July 18, 2022. doi:10.1186/s13063-019-3549-3