Antibiotic prophylaxis in severe acute pancreatitis

Beger, H. G.; Rau, Bettina; Isenmann, Rainer; Schwarz, Michael; Gansauge, Frank; Poch, Bertram

doi:10.1159/000084485

Cited by 50 publications

(41 citation statements)

References 41 publications

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“…The largest randomized placebo-controlled, double blind trial has been able to demonstrate that antibiotic prophylaxis with ciprofl oxacin and metronidazole has no benefi cial effects with regard to the reduction of pancreatic infection and the decrease of hospital mortality. This trial does not support antibiotic prophylaxis in all patients with necrotizing pancreatitis, but in specifi c subgroups of patients with pancreatic necrosis and a complicated course [2].…”

Section: Review Articlementioning

confidence: 83%

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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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Section: Review Articlementioning

confidence: 83%

“…Its mortality rate is 5-10% in sterile and 15-40% in infected pancreatic necrosis [1,2]. Incidence of AP seems to be rising in western countries.…”

Section: Review Articlementioning

confidence: 99%

Antibiotics in severe acute pancreatitis

Serrablo

Tejedor²,

Martínez

2014

Open Medicine

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“…The clinical data from this trial do not support antibiotic prophylaxis in all patients with necrotising pancreatitis but in subgroups of patients with pancreatic necrosis and a complicated clinical course. 35 The International Consensus conference of April 2004 also recommends against the use of prophylactic antibiotics in all cases of necrotising pancreatitis in view of inconclusive evidence and divided expert opinion. 36 However it is still agreed that the benefits of prophylactic antimicrobial therapy needs to be further addressed in the form of well-designed clinical trials and further research in this area.…”

Section: Prevention Of Infectionmentioning

confidence: 99%

Acute Severe Necrotising Pancreatitis Is Really a Surgical Challenge: An Overview

Choudhury¹

2015

jemds

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Necrotic pancreatitis is a severe form of acute pancreatitis where morbidity and mortality associated with this type of acute pancreatitis are comparatively higher especially when it is also infected. It is estimated to be around 10-24% whereas less than 1% is if in mild form. Despite relative less study, there has been a significant change in the management of acute necrotising pancreatitis over the past two decades. Although 75% to 80% of cases of acute pancreatitis is a mild disease without associate mortality it is important to identify the 20% to 25% of patients who are likely to develop severe disease associated with major complications and who would benefit from early intensive care monitoring and treatment. In recent years the treatment of acute necrotising pancreatitis has shifted away from early surgical debridement (Necrosectomy) to aggressive intensive medical care of multiple organ systems with specific criteria for operative and non-operative management. This review presents the current concepts with regards to diagnosis and management of acute necrotising pancreatitis including the variation of opinion in most critical aspects. Some of the issues addressed include the management of these patients in an intensive care/ therapy unit, the role of prophylactic antibiotics, requirement of nutrition, enteral and/or parenteral and pre-surgical resuscitative management, the role of CT scan and FNAC in diagnosing infection and finally the role of surgery.

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“…Meropenem and piperacillin distributed into the extracellular space, and their distribution kinetics were unaffected by pancreatitis. In contrast, in pancreatic cells from animals with pancreatitis, ciprofloxacin showed a reduced uptake and clindamycin showed a reduced distribution.Although the use of antibiotics in treating pancreatitis still remains controversial (3,4,15), bacterial infection is the leading cause of morbidity and mortality in patients with severe acute pancreatitis (SAP) (14). Studies have investigated penetration into diseased human tissue (1, 2, 5, 13), as well as a variety of animal models (6, 9, 10, 16).…”

mentioning

confidence: 99%

“…Although the use of antibiotics in treating pancreatitis still remains controversial (3,4,15), bacterial infection is the leading cause of morbidity and mortality in patients with severe acute pancreatitis (SAP) (14). Studies have investigated penetration into diseased human tissue (1, 2, 5, 13), as well as a variety of animal models (6, 9, 10, 16).…”

mentioning

confidence: 99%

Changes in Antibiotic Distribution Due to Pancreatitis

Fanning¹,

Robertson²,

Prins³

et al. 2011

Antimicrob Agents Chemother

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This work sought to define how pancreatitis affected antibiotic distribution in a perfused rat pancreas model. The distribution kinetics of four antibiotics were examined in control animals and animals with pancreatitis. Meropenem and piperacillin distributed into the extracellular space, and their distribution kinetics were unaffected by pancreatitis. In contrast, in pancreatic cells from animals with pancreatitis, ciprofloxacin showed a reduced uptake and clindamycin showed a reduced distribution.Although the use of antibiotics in treating pancreatitis still remains controversial (3,4,15), bacterial infection is the leading cause of morbidity and mortality in patients with severe acute pancreatitis (SAP) (14). Studies have investigated penetration into diseased human tissue (1, 2, 5, 13), as well as a variety of animal models (6, 9, 10, 16).However, there appear to be few studies examining the rate of antibiotic uptake into pancreatic tissue. To our knowledge, this is one of the few studies investigating the rate of uptake of antibiotics in normal and diseased pancreas and most likely the first in the isolated perfused pancreas. Such a model enables the precise rate of uptake and efflux for antibiotics in the pancreas to be defined, as well as the nature of their distribution in the normal and diseased pancreas.All procedures involving animals were carried out with adherence to the University of Queensland Animal Care Committee guidelines (Animal Ethics Committee [AEC] project PAH/588/06/NHMRC). Pancreatitis was induced by giving male Wistar rats a single injection of 6 mg of dibutyltin dichloride (DBTC) per kg of body weight, via the tail vein, according to a previously described method (16). Rats were not allowed to eat from 104 h postinjection, and following the final blood sample at 120 h postinjection, they were anesthetized as previously described (8). The pancreas perfusions were carried out similarly to the method described previously (8) with a series of 5 individual 20-l bolus injections (7): piperacillin (2 mg/ml), meropenem (1 mg/ml), ciprofloxacin (200 g/ml), clindamycin (1 mg/ml), and [14 C]sucrose with 3 H-labeled water (each drug bolus contained 125 I-labeled albumin). The perfusate and outflow profiles were analyzed as described previously to obtain the unbound fraction in perfusate (fu), volume of distribution of albumin or albumin space (V alb ), volume of distribution of sucrose or sucrose space (V suc ), volume of distribution of water or water space (V water ), drug distribution volume (V), fraction unbound in tissues (fu T ), permeation rate constant k in (permeability rate constant from the vascular space to the extravascular space), efflux rate constant k out (permeability rate constant from the extravascular space to the vascular space), and permeability surface area product (PS) (7, 8). Fibrosis was quantified using a method that has been previously utilized for the liver (11).Histological examination of the diseased pancreas showed pathologies, including the formation of ductal comp...

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Antibiotic prophylaxis in severe acute pancreatitis

Cited by 50 publications

References 41 publications

Antibiotics in severe acute pancreatitis

Antibiotics in severe acute pancreatitis

Acute Severe Necrotising Pancreatitis Is Really a Surgical Challenge: An Overview

Changes in Antibiotic Distribution Due to Pancreatitis

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