In individuals with acute pancreatitis, a procalcitonin-guided algorithm can lower the need for antibiotics without worsening infection or damage.

A randomized controlled trial (PROCAP) was carried out to assess whether a procalcitonin-based algorithm for initiation, continuation, and termination of antibiotics can elicit decreased antibiotic usage without having a negative impact on the course of acute pancreatitis.

This single-centred, patient-blinded study enrolled 260 people (aged 18 years and above) who had a clinical diagnosis of acute pancreatitis. Using web-based randomization software, candidates were randomly allocated to procalcitonin-guided care (132 participants) or standard/usual care (128 participants). The randomization sequence was stratified via disease severity and admission pathway.

On days 0, 4, 7, and weekly after that, procalcitonin testing was performed in the procalcitonin-based care group. After a test value of less than 1 ng/mL, antibiotics should be stopped or not started. On the other hand, after a test value of 1 ng/mL or more, antibiotics should be started or continued. Any kind of empirical decision to employ antibiotics in the intervention group was found to be preceded by a procalcitonin assay. The other standard of treatment was provided to both groups. Usage of antibiotics during index admission to hospital was the key endpoint ascertained. All the assessments were carried out in the intention-to-treat population.

Antibiotics were provided to 59 (45%) people in the procalcitonin-based care group versus 79 (63%) in usual care group (adjusted risk difference -15.6%). The treatment effect odds ratio was 0.49. The number of clinical infections or infections acquired in the hospital per patient did not considerably vary between the groups. Notably, 3 (2%) subjects in the usual care group and 4 (3%) subjects in the procalcitonin-based care group passed away. All of these deaths were caused by underlying severe pancreatitis. Adverse occurrences between the two groups were similar.

Procalcitonin-guided care for initiation, continuation, and discontinuation of antibiotics appears to be beneficial for acute pancreatitis patients.