Procalcitonin-Guided Therapy Can Improve Antibiotic Stewardship in Acute Pancreatitis

Two thirds of patients who present to the hospital with acute pancreatitis receive at least one dose of antibiotics. Because serum procalcitonin is more sensitive than clinical and routine laboratory assessment in detecting pancreatic infection, U.K. investigators tested whether procalcitonin-guided protocols lowered antibiotic use in a single-center study of 260 inpatients with acute pancreatitis.

Patients were randomized to procalcitonin-guided therapy (tested on days 0, 4, and 7, and weekly thereafter) or usual care. In the procalcitonin group, any decision about antibiotic use was preceded by a procalcitonin test (guidance was to stop or not start antibiotics at a value <1 ng/mL and to start or continue at a value ≥1 ng/mL). Antibiotic u…