Evaluation of prophylactic antibiotics in acute pancreatitis

Prophylactic antibiotics in acute pancreatitis: endless debate

“…The role of prophylactic antibiotics to prevent infection and reduce mortality in pancreatitis was first evaluated in the 1970s, where several randomised controlled trials (RCTs) had been conducted and concluded that prophylactic antibiotics were effective in preventing secondary pancreatic infections and therefore in reducing the related mortality. [4][5][6] However, in the 2000s, there have been multiple large controlled trials, with conflicting results, 7-9 different consensuses reached and differing guidelines for the use of prophylactic antibiotics. 10,11 We review the literature and the different attitudes towards and guidelines for the routine use of prophylactic antibiotics to prevent infectious complications and decrease the mortality from acute pancreatitis, and outline the situations where antibiotics may have a definite role and should be used.…”

Behavior of antibiotics during human necrotizing pancreatitis

“…The choice of antibiotics in preventing infected necrosis during necrotizing pancreatitis should be based on their antimicrobial activity, penetration rate, persistence, and therapeutic concentrations in the necrotic pancreatic area. These requisites are provided by pefloxacin and metronidazole and to a variable extent by imipenem and mezlocillin.Superinfection of necrotic tissue in the course of acute necrotizing pancreatitis is a decisive prognostic factor with regard to morbidity and mortality (2,3,5,7,20,25,33,34,40).This has prompted attempts to identify the patients at septic risk (3,5,20), the microorganisms responsible for the superinfection (1), the times of infection in the natural history of the disease (3,20), the therapeutic measures to be adopted (1-3, 5, 20, 34), and possible effective prophylaxis (7,9,10,19,23,25,33).The ideal antibiotic for therapy and/or prophylaxis should be targeted at the microorganisms responsible for the septic complications and should reach the infection site in therapeutic concentrations.To date, several studies have been conducted to evaluate the penetration of various different antibiotics into healthy pancreatic tissue and juice (4, 7-11, 28, 35-38). None of these studies has been conducted with humans in the course of disease, and to the best of our knowledge, the effective ability of antibiotics to penetrate the infection risk areas has never been assessed.…”

“…This has prompted attempts to identify the patients at septic risk (3,5,20), the microorganisms responsible for the superinfection (1), the times of infection in the natural history of the disease (3,20), the therapeutic measures to be adopted (1-3, 5, 20, 34), and possible effective prophylaxis (7,9,10,19,23,25,33).…”

Antibiotics in severe acute pancreatitis

“…This heterogeneity makes meta-analysis less reliable and indicates the need for further double blind randomised controlled trials. Early studies on antibiotic prophylaxis did not show benefi t, probably because the selected antibiotic, ampicilin, has not good pancreatic tissue diffusion (Table 2), [23][24][25] although the trial of Finch et al was a well designed, randomized, double blind study (unrepeated for the following 30 years). More recently, several others prospective trials, using broad-spectrum antibiotics with good pancreatic diffusion, have shown a signifi cant decrease in the infection rate of pancreatic necrosis [18], sepsis incidence [16] and mortality rate compared with patients not receiving antibiotic prophylaxis (Table 3) [20].…”