A Double-blind, Placebo-controlled Trial of Ciprofloxacin Prophylaxis in Patients with Acute Necrotizing Pancreatitis

García-Barrasa, Arantxa; Borobia, Francisco G.; Pallarés, Román; Jorba, Rosa; Poves, Ignasi; Busquets, Juli; Fabregat, Joan

doi:10.1007/s11605-008-0773-7

Cited by 99 publications

(57 citation statements)

References 32 publications

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“…There was no difference of mortality. Garcia-Barrasa et al 18 evaluated the use of ciprofloxacin for infection prophylaxis of pancreatic necrosis and also did not observe difference of mortality or of necrosis infection.…”

Section: Introductionmentioning

confidence: 97%

Management of infected pancreatic necrosis: state of the art

Rasslan

Novo

Bitran

et al. 2017

Rev. Col. Bras. Cir.

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Pancreatic necrosis occurs in 15% of acute pancreatitis. The presence of infection is the most important factor in the evolution of pancreatitis. The diagnosis of infection is still challenging. Mortality in infected necrosis is 20%; in the presence of organic dysfunction, mortality reaches 60%. In the last three decades, there has been a real revolution in the treatment of infected pancreatic necrosis. However, the challenges persist and there are many unsolved questions: antibiotic treatment alone, tomography-guided percutaneous drainage, endoscopic drainage, video-assisted extraperitoneal debridement, extraperitoneal access, open necrosectomy? A step up approach has been proposed, beginning with less invasive procedures and reserving the operative intervention for patients in which the previous procedure did not solve the problem definitively. Indication and timing of the intervention should be determined by the clinical course. Ideally, the intervention should be done only after the fourth week of evolution, when it is observed a better delimitation of necrosis. Treatment should be individualized. There is no procedure that should be the first and best option for all patients. The objective of this work is to critically review the current state of the art of the treatment of infected pancreatic necrosis.

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Section: Introductionmentioning

confidence: 97%

Management of infected pancreatic necrosis: state of the art

Rasslan

Novo

Bitran

et al. 2017

Rev. Col. Bras. Cir.

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“…Antibiotic prophylaxis to reduce infective complications in acute pancreatitis was evaluated in a series of randomized trials [4][5][6][7][8][9][10][11][12]. However meta-analyses of these trials do not support antibiotic prophylaxis in acute pancreatitis [13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Antibiotic use in acute pancreatitis: An audit of current practice in a tertiary centre

et al. 2016

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“…Three types of antibiotics, carbapenems, fluoroquinolones, and cephalosporins, have been found to penetrate into the pancreas [8,9]. During the past decades, a number of studies have been done in order to determine whether it is necessary to administer antibiotics for ANP with conflicting results [10,11,12,13,14,15,16,17,18]. Meta-analyses have also been inconclusive [19,20,21,22,23,24].…”

Section: Introductionmentioning

confidence: 99%

Prophylactic Antibiotics Reduce Pancreatic Necrosis in Acute Necrotizing Pancreatitis: A Meta-Analysis of Randomized Trials

Yao

Huang²,

Li³

et al. 2010

Dig Surg

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Background and Aim: The use of prophylactic antibiotics to prevent infection and reduce mortality in patients with acute necrotizing pancreatitis (ANP) remains controversial. The aim of this study is to perform a systematic review of the data from randomized controlled trials to compare prophylactic antibiotic treatment of patients with ANP versus placebo. Methods: A computerized literature search was conducted using Medline, PubMed, EMBase and Cochrane Central Register of Controlled Trials (CENTRAL) for relevant articles published in English from January 1990 to March 2010. MeSH terms and keywords used to identify articles included ‘antibiotic’, ‘pancreatitis’, and ‘randomized’. Outcome measures were infected pancreatic necrosis (IPN), mortality, nonpancreatic infection (NPN) and need for surgical intervention. Results: Nine trials involving 564 patients were included. Analysis suggested that IPN was significantly reduced by treatment with antibiotics (RR 0.73, 95% CI 0.54–0.98, p = 0.04). Mortality (p = 0.1), NPN (p = 0.07), and need for surgical intervention (p = 0.17) were not significantly reduced by antibiotic treatment. Subsequent subgroup analysis confirmed that antibiotics were statistically superior to controls in reducing of infected necrosis (p = 0.003) and also mortality (p = 0.02) in single-blinded randomized controlled trials. Conclusion: Prophylactic antibiotic treatment reduced occurrence of IPN, but did not affect mortality, NPN, or surgical intervention in patients with ANP.

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A Double-blind, Placebo-controlled Trial of Ciprofloxacin Prophylaxis in Patients with Acute Necrotizing Pancreatitis

Abstract: The prophylactic use of ciprofloxacin in patients with severe necrotizing pancreatitis did not significantly reduce the risk of developing pancreatic infection or decrease the mortality rate. The small number of patients included in this study should be considered.

Cited by 99 publications

References 32 publications

Management of infected pancreatic necrosis: state of the art

Management of infected pancreatic necrosis: state of the art

Antibiotic use in acute pancreatitis: An audit of current practice in a tertiary centre

Prophylactic Antibiotics Reduce Pancreatic Necrosis in Acute Necrotizing Pancreatitis: A Meta-Analysis of Randomized Trials

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