Huang et al reported an procalcitonin-based algorithm for antibiotic therapy of a patient with secondary peritonitis. This can help to optimize antibiotic therapy without jeopardizing the patient. The authors are from National Taiwan University, Chang Gung Memorial Hospital, National Yang-Ming University and Taipei City Hospital in Taiwan.
Patient selection: secondary peritonitis with bowel perforation
Outcome: duration of antibiotic therapy
Assay for Procalcitonin: Brahms PCT Krypto assay; linear range: 0.02 to 50 ng/mL undiluted, up to 5,000 with serial dilution
Algorithm - Antibiotic therapy was discontinued if both of the following:
(1) signs of infection improved, afebrile and tolerant of an oral diet
(2) procalcitonin concentration (at least one of the following):
(2a) < 1.0 ng/mL
(2b) decreased by >= 80% compared to the initial pre-operative concentration following surgery (postoperative level <= 20% of pre-operative)
The procalcitonin assay was measured after antibiotics were discontinue to detect any rise that might indicate relapse.
In many patients antibiotic therapy could be limited to 4-7 days after surgery.
Risk factors associated with longer periods of antibiotic therapy:
(1) advanced age
(2) pulmonary disease
(3) high APACHE II score (>= 15)
