Effect of antibiotic prophylaxis on acute necrotizing pancreatitis: results of a randomized controlled trial.
OBJECTIVE
This study addresses whether antibiotic prophylaxis is beneficial for acute necrotizing pancreatitis.


METHODS
This randomized, controlled trial enrolled 276 patients with severe acute pancreatitis. There were 56 patients with 30% or more necrosis proved by contrast-enhanced computerized tomography who were eligible for randomization: 29 in the study group and 27 in the control group, who received i.v. imipenem-cilastatin (3 x 500 mg/day) within 72 h of the onset of symptoms for 7-14 days, and no antibiotic prophylaxis, respectively. The primary end-point was the incidence of infectious complication. The secondary end-points were mortality, the incidence of necrosectomy for infected necrosis, the incidence of organ complication and hospital courses.


RESULTS
Characteristics of baseline data were similar in the two groups. No significant differences were found in the incidence of infected pancreatic necrosis (37% vs 27.6%), mortality (10.3% vs 14.8%) and the incidence of operative necrosectomy (29.6% vs 34.6%) between the study group and the control group (P > 0.05). The incidence of extrapancreatic infections, organ complications and hospital courses between the groups were also not significantly different. However, a significantly increased incidence of fungal infection was observed in the study group versus the control group (36.1% vs 14.2%, P < 0.05).


CONCLUSIONS
There was no benefit in the outcomes when antibiotic prophylaxis was routinely used in patients with acute necrotizing pancreatitis.
Xue
Ping
P
Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
Deng
Li-Hui
LH
Zhang
Zhao-Da
ZD
Yang
Xiao-Nan
XN
Wan
Mei-Hua
MH
Song
Bing
B
Xia
Qing
Q
D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D019072:Antibiotic Prophylaxis / Q000009:adverse effects; D002097:C-Reactive Protein / Q000378:metabolism; D015377:Cilastatin / Q000008:administration & dosage / Q000009:adverse effects; D000077728:Cilastatin, Imipenem Drug Combination; D018450:Disease Progression; D004338:Drug Combinations; D005260:Female; D006801:Humans; D015378:Imipenem / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000139:chemically induced; D010179:Pancreas / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000601:surgery; D010180:Pancreatectomy; D010195:Pancreatitis / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D019283:Pancreatitis, Acute Necrotizing / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology / Q000517:prevention & control* / Q000601:surgery; D018579:Patient Selection; D012720:Severity of Illness Index; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D004338:Drug Combinations; D015377:Cilastatin; D015378:Imipenem; D002097:C-Reactive Protein; D000077728:Cilastatin, Imipenem Drug Combination