Antibiotic Prophylaxis in Acute Necrotizing Pancreatitis Revisited

Segarra‐Newnham, Marisel; Hough, Augustus

doi:10.1345/aph.1m153

Cited by 5 publications

(3 citation statements)

References 44 publications

(15 reference statements)

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“…The authors further reasoned that there might have been an apparent publication bias in the period before 2000 but that certain patients with severe pancreatitis could still benefit from antibiotic prophylaxis. In line with this meta-analysis, nearly all new but also some older reviews and meta-analyses [ 10 , 12 , 17 , 19 , 20 , 21 , 23 , 25 , 29 , 30 , 39 , 40 ] conclude that a general recommendation for prophylactic antibiotics cannot be given. Most of these authors also see a need for better trials since some subgroups might benefit from antibiotics.…”

Section: Recommendations For/against Prophylactic Antibiosismentioning

confidence: 52%

“…However, the data for the outcome of the patients receiving prophylactic antibiosis are conflicting. In this review, we will summarize meta-analyses and reviews on this issue [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ] (please also refer to table 1 for a short summary of the included meta-analyses) and will not discuss the original data in detail.…”

Section: Recommendations For/against Prophylactic Antibiosismentioning

confidence: 99%

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Antibiosis of Necrotizing Pancreatitis

et al. 2014

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Background: Necrotizing pancreatitis is a life-threatening presentation of acute pancreatitis. The mortality of 20-80% initially depends on the persistence of organ failure and systemic inflammatory response syndrome (SIRS) and, in the later course of the disease, on secondary infection of the necrosis. The questions whether prophylactic antibiotics aiming to prevent this infection should be administered and which antibiotic is the best to use, as well as the problem of fungal infection under antibiotic treatment are still intriguing and insufficiently solved. Methods: A search of the literature using PubMed was carried out, supplemented by a review of the programmes of the Digestive Disease Week (DDW) and the United European Gastroenterology Week (UEGW). Results: Despite the widely practised prophylactic antibiotic administration in severe pancreatitis, no evidence for the benefit of this strategy exists. One of the drawbacks might be a tendency for disastrous fungal infection under prophylactic antibiotics. Bacterial translocation from the gut in the second week after the onset of symptoms is the major source for infection of pancreatic necrosis and provides a clear indication for antibiotic treatment. However, routine fine-needle aspiration for a calculated antibiotic therapy cannot be recommended, and all other tests offer only indirect signs. Important factors such as enteral versus parenteral feeding and the method of necrosectomy are mostly neglected in the trials but seem to be essential for the outcome of the patient. Conclusions: Even though most meta-analyses including the newer double-blind, placebo-controlled trials on prophylactic antibiotics showed no beneficial effects in the prevention of infection of necrosis and/or outcome of the patients, this strategy is still widely used in clinical routine. Since nearly all trials published so far show systematic problems (i.e. inaccurate definition of the severity of the disease, poor statistical testing, and neglect of differences in the route of nutrition), there is a need for randomized controlled prospective trials with exact definitions of the disease.

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Section: Recommendations For/against Prophylactic Antibiosismentioning

confidence: 52%

Section: Recommendations For/against Prophylactic Antibiosismentioning

confidence: 99%

Antibiosis of Necrotizing Pancreatitis

et al. 2014

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“…They should be initiated "on demand" (Table 7) and kept no more than 14 days without microbiological demonstration of infection. When comparing prophylaxis and on demand use of ciprofloxacin and metronidazole, Iganatavicius et al concluded that the use of prophylactic antibiotics does not affect mortality rate, but may decrease the need for interventional and surgical management and lower the number of reoperations, [67] while other authors only recommend on demand use of antibiotics [68].…”

Section: Antibiotic Selection In Infected Acute Pancreatitismentioning

confidence: 99%

Antibiotics in severe acute pancreatitis

Serrablo

Tejedor²,

Martínez

2014

Open Medicine

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AbstractAcute pancreatitis (AP) is a local inflammatory response with systemic effects and an adverse evolution in 20% of cases. Its mortality rate is 5–10% in sterile and 15–40% in infected pancreatic necrosis. Infection is widely accepted as the main reason of death in AP. The evidence to enable a recommendation about antibiotic prophylaxis against infection of pancreatic necrosis is conflicting and difficult to interpret. Up to date, there is no evidence that supports the routine use of antibiotic prophylaxis in patients with severe AP. Treatment on demand seems to be the better option, avoiding excessive treatment and selection of bacterial. In infected acute pancreatitis, antibiotics of choice are imipenem, meronem or tigecycline in patients allergic to beta-lactams. Also fluconazole must be given in determinate clinical situations.

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Pancreatitis

Forsmark¹

2012

Goldman's Cecil Medicine

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Antibiotic Prophylaxis in Acute Necrotizing Pancreatitis Revisited

Cited by 5 publications

References 44 publications

Antibiosis of Necrotizing Pancreatitis

Antibiosis of Necrotizing Pancreatitis

Antibiotics in severe acute pancreatitis

Pancreatitis

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