Procalcitonin-guided use of antibiotics in acute pancreatitis

In the PROCAP study, Ajith Siriwardena and colleagues 1 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. Lancet Gastroenterol Hepatol. 2022; 7: 913-921 Summary Full Text Full Text PDF PubMed Scopus (4) Google Scholar showed lower rates of antibiotic prescriptions in patients with acute pancreatitis who received procalcitonin-guided care (59 [45%] of 132 vs 79 [63%] of 128 in those who received usual care) and a shorter antibiotic duration (4·5 days [SD 10·5] vs 5·8 days [10·6]), despite similar secondary infection rates or hospital stay. However, there are some caveats to this interpretation. Procalcitonin-guided use of antibiotics in acute pancreatitis – Authors' replyWe thank Bilal Ahmad Mir and colleagues and Jayanta Samanta and Jahnvi Dhar for their interest in our study.1 First, in relation to whether to restrict the procalcitonin assay to patients with moderate or severe acute pancreatitis, there is evidence of misuse of antibiotics regardless of disease severity and globally across health-care systems.2 Furthermore, current definitions of severe disease require persistent organ dysfunction after 48 h of treatment and final allocated severity might not be apparent at presentation. Full-Text PDF Procalcitonin-guided use of antibiotics in acute pancreatitisAcute pancreatitis is characterised by an early phase of sterile inflammation that mimics systemic infections and leads to indiscriminate use of antibiotics in most cases. This crucial issue has been addressed by Ajith Siriwardena and colleagues,1 but a few aspects of the study need intricate analysis. Full-Text PDF A procalcitonin-based algorithm to guide antibiotic use in patients with acute pancreatitis (PROCAP): a single-centre, patient-blinded, randomised controlled trialOur findings suggest that procalcitonin-guided care can reduce antibiotic use without increasing infection or harm in patients with acute pancreatitis. Procalcitonin-based algorithms to guide antibiotic use should be considered in the care of this group of patients and be incorporated into future guidelines on the management of acute pancreatitis. Full-Text PDF