Effect of different regimens of gut decontamination on bacterial translocation and mortality in experimental acute pancreatitis.
OBJECTIVE
To assess the effect of four regimens of antibiotics (compared with a control regimen of distilled water) given orally on gut decontamination, bacterial translocation, and mortality in acute necrotising pancreatitis in mice.


METHODS
Randomised experimental study.


METHODS
University hospitals, USA and Italy.


METHODS
150 young Swiss Webster mice.


METHODS
All mice were fed a diet deficient in choline and supplemented with ethionine. They were then randomised to be given by gavage (36 hours after starting the diet): distilled water (controls, group 1); aztreonam along (group 2); neomycin, erythromycin, metronidazole (group 3); polymyxin B and amikacin (group 4); polymyxin B, amikacin, amphotericin B (group 5). 20 Mice in each group were treated for 10 days, and the remaining 10 in each group were killed after 3 days.


METHODS
Survival, and qualitative and quantitative cultures of the liver, lungs, pancreas and caecum.


RESULTS
The best survival rate during the first 7 days was in group 5, but by day 10 there was no difference among the groups. All the antibiotic regimens reduced the number of bacteria in the caecum and all but aztreonam alone (group 2) reduced the rate of translocation of both Gram negative and Gram positive bacteria to all organs studied. Translocation of yeast occurred in those animals in groups 2, 3, and 4 in which there was overgrowth of fungi in the caecum.


CONCLUSIONS
Gram negative and Gram positive organisms and fungi may have an important role in infective morbidity and mortality in acute pancreatitis, and selective decontamination with polymyxin B, amikacin, amphotericin B reduced the incidence of translocation related infections and early mortality in mice with acute necrotising pancreatitis.
Gianotti
L
L
Department of Surgery, University of Cincinnati, School of Medicine, Ohio, USA.
Munda
R
R
Gennari
R
R
Pyles
R
R
Alexander
J W
JW
D000208:Acute Disease; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003666:Decontamination; D004917:Erythromycin / Q000008:administration & dosage; D006090:Gram-Negative Bacteria / Q000187:drug effects; D006094:Gram-Positive Bacteria / Q000187:drug effects; D007422:Intestines / Q000187:drug effects / Q000382:microbiology*; D008795:Metronidazole / Q000008:administration & dosage; D009336:Necrosis / Q000382:microbiology; D009355:Neomycin / Q000008:administration & dosage; D010195:Pancreatitis / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality / Q000473:pathology; D011112:Polymyxin B / Q000008:administration & dosage; D051381:Rats; D011919:Rats, Inbred Strains; D015996:Survival Rate
D000900:Anti-Bacterial Agents; D008795:Metronidazole; D004917:Erythromycin; D009355:Neomycin; D011112:Polymyxin B