title: Effects of prophylactic antibiotics in acute pancreatitis.
abstract: OBJECTIVE
  The use of prophylactic antibiotics in severe acute pancreatitis (SAP) is controversial. The aim of this study was to compare the effects of antibiotics administered as prophylaxis and as treatment on demand, respectively, in two prospective, non-randomized cohorts of patients.
  
  
  METHODS
  The study population consisted of 210 patients treated for SAP. In Group 1 (n= 103), patients received prophylactic antibiotics (ciprofloxacin, metronidazole). In Group 2 (n= 107), patients were treated on demand. Ultrasound-guided drainage and/or surgical debridement of infected necrosis were performed when the presence of infected pancreatic necrosis was demonstrated. The primary endpoints were infectious complication rate, need for and timing of surgical interventions, incidence of nosocomial infections and mortality rate.
  
  
  RESULTS
  Ultrasound-guided fine needle aspiration [in 18 (16.8%) vs. 13 (12.6%) patients; P= 0.714], ultrasound-guided drainage [in 15 (14.0%) vs. six (5.8%) patients; P= 0.065] and open surgical necrosectomy [in 10 (9.3%) vs. five (4.9%) patients; P= 0.206] were performed more frequently and earlier [at 16.6 ± 7.8 days vs. 17.2 ± 6.7 days (P= 0.723); at 19.5 ± 9.4 days vs. 24.5 ± 14.2 days (P= 0.498), and at 22.6 ± 13.5 days vs. 26.7 ± 18.1 days (P= 0.826), respectively] in Group 2 compared with Group 1. There were no significant differences between groups in mortality and duration of stay in the surgical ward or intensive care unit.
  
  
  CONCLUSIONS
  The results of this study support the suggestion that the use of prophylactic antibiotics does not affect mortality rate, but may decrease the need for interventional and surgical management, and lower the number of reoperations.
authors.affiliation: Department of Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Povilas
authors.initials: P
authors.lastname: Ignatavicius
authors.forename: Astra
authors.initials: A
authors.lastname: Vitkauskiene
authors.forename: Juozas
authors.initials: J
authors.lastname: Pundzius
authors.forename: Zilvinas
authors.initials: Z
authors.lastname: Dambrauskas
authors.forename: Giedrius
authors.initials: G
authors.lastname: Barauskas
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis; D001424:Bacterial Infections / Q000382:microbiology / Q000401:mortality / Q000517:prevention & control*; D002939:Ciprofloxacin / Q000008:administration & dosage*; D003646:Debridement; D004322:Drainage; D004334:Drug Administration Schedule; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008097:Lithuania; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage*; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D011446:Prospective Studies; D012086:Reoperation; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole; D002939:Ciprofloxacin