Antibiotic prophylaxia in patients with severe acute pancreatitis.
BACKGROUND
The prophylactic use of antibiotics in patients with severe acute pancreatitis remains contentious. This study was undertaken to review the current studies on antibiotic prophylaxis in patients with severe acute pancreatitis.


METHODS
All papers found by a Medline search were relevant to human trials of antibiotic prophylaxis in patients with severe acute pancreatitis.


RESULTS
In the 1970s, three small randomized studies of prophylactic ampicillin in the treatment of acute pancreatitis showed no effect on mortality or morbidity, but the inclusion of patients at low risk for infection and the use of an ineffective antibiotic were insufficient to detect any differences. From 1993 to 2001, eight prospective clinical trials of antibiotic prophylaxis were conducted in patients with severe acute pancreatitis (SAP). Seven of the 8 trials showed significant effect of the prophylaxis in prevention of pancreatic infections, and one showed significant improvement of clinical course documented by the Acute Physiology and Chronic Health Evaluation II (APACHE II) scores. Only two trials did demonstrate the significance of the prophylaxis in lowering the mortality rate. Despite variations in drug agents, study size and patient selection, duration of treatment, and methodology (None of the studies was double-blinded), a meta-analysis showed the positive effect of antibiotics in reducing the mortality. We suggested that antibiotic prophylaxis with proven efficacy in necrotic pancreatic tissues should be given to all patients with acute necrotizing pancreatitis. In recent years, however, the first double-blind, placebo-controlled multicenter study from Germany detected no benefit of antibiotic prophylaxis with respect to the risk of developing infected pancreatic necrosis.


CONCLUSIONS
Prophylactic antibiotics for severe acute pancreatitis is still a matter of discussion and further studies are required to provide adequate data to answer many questions and to define the role of antibiotic prophylaxis in patients with severe acute pancreatitis.
Zhou
Yan-Ming
YM
Department of General Surgery, First Affiliated Hospital of Lanzhou Medical College, Lanzhou 730000, China. zhouyms@yahoo.com.cn
Xue
Zuo-Liang
ZL
Li
Yu-Min
YM
Zhu
You-Quan
YQ
Cao
Nong
N
D018806:APACHE; D000900:Anti-Bacterial Agents; D019072:Antibiotic Prophylaxis / Q000379:methods*; D002681:China; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D010186:Pancreatic Function Tests; D019283:Pancreatitis, Acute Necrotizing / Q000175:diagnosis / Q000188:drug therapy*; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents