title: Timing of antibiotic prophylaxis in acute pancreatitis: a controlled randomized study with meropenem.
abstract: OBJECTIVE
  Antibiotic prophylaxis improves the outcome of acute pancreatitis. Since bacterial translocation from the gut occurs in the first h of disease, early therapy is likely to achieve the maximal effect. The study compares early antibiotic treatment with treatment started after the demonstration of pancreatic necrosis.
  
  
  METHODS
  Two hundred fifteen patients with pancreatitis were randomized to either group A (N=108), who started antibiotic therapy (meropenem 500 mg t.i.d.) at admission, or group B (N=107), who received antibiotics after the demonstration of necrosis at computed tomography (CT). CT was performed in both groups after at least 48 hr of hospitalization. The clinical course of disease was compared in the two groups.
  
  
  RESULTS
  Thirty patients in group A and 29 in B showed necrosis on CT. The two groups were similar in demographics and characteristics of disease. Antibiotic treatment was started after 4.56+/-1.2 days from hospitalization in group B and after 1.07+/-0.6 days in A. Pancreatic infection occurred in four patients in group A (13.3%) and in nine in B (31%) (p=0.1). Extrapancreatic infection occurred in 16.6% of patients in group A and in 44.8% in B (p<0.05). Need for surgery and length of hospitalization were also higher in group B. Mortality rates were similar in the two groups, but, 3 of 4 patients with infected necrosis in group A and only 2 of 9 in group B died.
  
  
  CONCLUSIONS
  Early antibiotic treatment is associated with a significant improvement in the prognosis of necrotizing acute pancreatitis (AP), because of a reduction in the occurrence of septic complications.
authors.affiliation: Department of Gastroenterology, L. Sacco University Hospital, Milano, Italy.
authors.forename: Gianpiero
authors.initials: G
authors.lastname: Manes
authors.forename: Ilaria
authors.initials: I
authors.lastname: Uomo
authors.forename: Antonella
authors.initials: A
authors.lastname: Menchise
authors.forename: Pier Giorgio
authors.initials: PG
authors.lastname: Rabitti
authors.forename: Elisa Chiara
authors.initials: EC
authors.lastname: Ferrara
authors.forename: Generoso
authors.initials: G
authors.lastname: Uomo
mesh_terms: D000328:Adult; D000368:Aged; D019072:Antibiotic Prophylaxis; D016009:Chi-Square Distribution; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D000077731:Meropenem; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000000981:diagnostic imaging / Q000188:drug therapy*; D013845:Thienamycins / Q000008:administration & dosage*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D013845:Thienamycins; D000077731:Meropenem