Effect of early and late antibiotic treatment in experimental acute pancreatitis in rats.
BACKGROUND
The clinical course in acute necrotizing pancreatitis is mainly determined by bacterial infection of pancreatic and peripancreatic necrosis. The effect of two antibiotic regimens for early and late treatment was investigated in the taurocholate model of necrotizing pancreatitis in the rat.


METHODS
Seventy male Wistar rats were divided into five pancreatitis groups (12 animals each) and a sham-operated group (10 animals). Pancreatitis was induced by intraductal infusion of 3% taurocholate under sterile conditions. Animals received two different antibiotic regimes (20 mg/kg imipenem or 20 mg/kg ciprofloxacin plus 20 mg/kg metronidazole) early at 2, 12, 20, and 28 h after induction of pancreatitis or late at 16 and 24 h after induction of pancreatitis or no antibiotics (control). Animals were examined after 30 h for pancreatic and extrapancreatic infection.


RESULTS
Early and late antibiotic treatment with both regimes could significantly reduce pancreatic infection from 58 to 8-25%. However, extrapancreatic infection was only reduced by early antibiotic therapy. While quinolones also reduced bacterial counts in small and large bowel, imipenem did not.


CONCLUSIONS
In our animal model of necrotizing pancreatitis, early and late treatment with ciprofloxacin/metronidazole and imipenem reduce bacterial infection of the pancreas. Extrapancreatic infection, however, is reduced significantly only by early antibiotic treatment. The effectivity of early antibiotic treatment in the clinical setting should be subject to further investigation with improved study design and sufficient patient numbers.
Schwarz
Michael
M
Department of General Surgery, University of Ulm, Ulm, Germany. michael.schwarz@eurosurgery.de
Poch
Bertram
B
Isenmann
Rainer
R
Kriese
Dietrich
D
Rozdzinski
Eva
E
Beger
Hans G
HG
Gansauge
Frank
F
D000818:Animals; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D002756:Cholagogues and Choleretics; D002939:Ciprofloxacin / Q000627:therapeutic use; D004195:Disease Models, Animal; D004359:Drug Therapy, Combination; D015378:Imipenem / Q000627:therapeutic use; D007422:Intestines / Q000382:microbiology; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D019283:Pancreatitis, Acute Necrotizing / Q000139:chemically induced / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D011897:Random Allocation; D051381:Rats; D017208:Rats, Wistar; D013656:Taurocholic Acid; D013997:Time Factors
D000890:Anti-Infective Agents; D002756:Cholagogues and Choleretics; D008795:Metronidazole; D013656:Taurocholic Acid; D002939:Ciprofloxacin; D015378:Imipenem