Prevention of infection following severe acute pancreatitis.
OBJECTIVE
This review highlights recently reported strategies aimed at quantifying severity of illness earlier in the course of acute pancreatitis and at preventing secondary infection in pancreatic necrosis.


RESULTS
New and improved scoring models appear to suggest that the optimal interventional window is between 24 and 72 h of the onset of severe acute pancreatitis. Prospective randomized clinical trials in which patients with severe acute pancreatitis were treated with broad-spectrum antimicrobial regimens as prophylaxis, however, have demonstrated no benefit in terms of preventing late infection in pancreatic necrosis. In contrast, early enteral nutrition with various formulas and supplements, including probiotics, may confer a clinical advantage in terms of morbidity and mortality.


CONCLUSIONS
Continuing to advocate antimicrobial prophylaxis in severe acute pancreatitis is not reasonable, in view of the evidence now available from two large clinical trials. Current guidelines should be revised because of the potential harm to gastrointestinal ecology associated with long-term antibiotic treatment. A suitable alternative way to prevent bacterial overgrowth and secondary infection is lacking, however.
Tellado
Jose M
JM
Department of Surgery, Hospital Gregorio Marañon, Madrid, Spain. jtellado.hgugm@salud.madrid.org
D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D006801:Humans; D017053:Infection Control / Q000379:methods*; D010195:Pancreatitis / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D014481:United States
D000900:Anti-Bacterial Agents