Role of Procalcitonin in Guiding Antibiotic Usage in Acute Pancreatitis – A Randomised Controlled Trial

Background The American College of Gastroenterology guidelines advise against prophylactic antibiotics for acute pancreatitis. However, 23.5% of cases receive them without evidence of infection. We aim to assess if a Procalcitonin(PCT) based algorithm can reduce antibiotic usage in patients with acute pancreatitis. Aims To compare antibiotic usage in terms of Defined Daily Dose (DDD), antibiotic usage, Length of hospitalization (LOH), re-admission & mortality rates in both the groups Methods This is a single-center, prospective, single-blinded, randomized controlled trial where patients with Acute Pancreatitis were randomized into PCT & non-PCT groups. The PCT group received antibiotics based on PCT values on day 0 of admission, with treatment initiated or continued, if started already, when PCT was ≥1.0 ng/mL and discontinued when PCT was <1.0 ng/mL. Based on PCT, patients were reassessed after 48 hours for starting/ continuing/ stopping antibiotics. PCT values were measured on days 4 & 7 of admission. The other group was treated based on the American Pancreatic Association Protocol. Antibiotic usage, Length of hospitalization, re-admission & mortality rates were analyzed in both groups. Results 152 patients were enrolled after screening 167 patients. 144 patients were analyzed, 73 in the non-PCT group and 71 in the PCT group. Antibiotic usage proportions were 45.2% in the non-PCT group and 36.6% in the PCT group, showing a 9% reduction which was not statistically significant (p=0.295). Despite subgroup analysis based on the severity of pancreatitis, there were no significant differences in antibiotic duration, hospital stay, readmission, or mortality rates. Conclusion Procalcitonin-based antibiotic usage algorithm, although reduced the proportion of patients receiving antibiotics, it didn’t reach statistical significance despite subgroup analysis based on the severity of pancreatitis.