Can serum procalcitonin measurement help monitor the treatment of acute bacterial meningitis? A prospective study

BACKGROUND Previous studies have demonstrated the value of serum procalcitonin (PCT) as a marker of bacterial infection, as well as the rapid decrease in its concentration with appropriate antibiotic treatment. The aim of this study was to determine the variation in serum PCT levels over time during the treatment of acute bacterial meningitis (ABM) in adults. METHODS In this prospective analytical study, 36 acute meningitis patients (26 males and 10 females) with mean age of 38.4±20.1 years were studied. Among them, 17 patients with fever and neck stiffness and CSF profiles consistence, ABM was treated by appropriate antibiotic regimen. We measured PCT serum levels before and after 24 and 72 hours after initiation of treatment. Decrease in the body temperature and feeling of well being were the clinical criteria for treatment response. The data were collected and analyzed. RESULTS Serum level of PCT in the beginning of treatment, 24 and 72 hours after initiation of treatment was 2.58±4.62, 2.50±4.6 and 1.52±3.03 ng/ml, respectively. Difference in PCT initially and 24 h later was 0.044±0.08 (p=0.025) and after 72 h was 1.74±2.92 (p=0.013). The mean of PCT level was greater in patients not improving (5.34±4.42 vs. 2.08±3.46). CONCLUSION Although decreasing PCT was low in 24 h after treatment, this decrement is more significant after 72 h. PCT serum level may be used as a follow up of treatment response in ABM.