Monitoring procalcitonin is of value in acute pancreatitis

doi:10.1136/bmj.329.7459.232-b

BMJ 2004;329:232 (24 July), doi:10.1136/bmj.329.7459.232-b

Letter

Monitoring procalcitonin is of value in acute pancreatitis

The first 150 words of the full text of this article appear below.

EDITOR—In their discussion of the important issue of antibioticprophylaxis in acute pancreatitis, I was surprised that O'Reillyand Kingsnorth made no mention of monitoring the plasma concentrationof procalcitonin.¹ A considerable literature now exists, establishingthe value of procalcitonin monitoring in acute pancreatitis,^2-4and it is our practice to use the APACHE II score and the valueof this inflammatory marker to guide the requirement for earlyantibiotic prophylaxis with a carbipenem and fluconazole.

A recent study has shown that the plasma concentration of procalcitoninmay reflect the derangement in gut barrier function (ratherthan the extent of systemic inflammation) and may hence predictthose patients in whom the translocation of bacteria and fungiinto dead pancreas is more likely.⁵

I agree with the authors that we do not want to give all patientswith acute pancreatitis antibiotic prophylaxis. But I have experienceof fatal acute pancreatitis . . . [Full text of this article]

David Bihari, associate professor

University of New South Wales Lismore Base Hospital, Lismore, NSW 2480, Australia biharid@aol.com