Antibiotic use in acute pancreatitis: An audit of current practice in a tertiary centre.
BACKGROUND
Intravenous antibiotic prophylaxis is not recommended in acute pancreatitis. According to current international guidelines antibiotics together with further intervention should be considered in the setting of infected necrosis. Appropriate antibiotic therapy particularly avoiding over-prescription is important. This study examines antibiotic use in acute pancreatitis in a tertiary centre using the current IAP/APA guidelines for reference.


METHODS
Data were collected on a consecutive series of patients admitted with acute pancreatitis over a 12 month period. Data were dichotomized by patients admitted directly to the centre and tertiary transfers. Information was collected on clinical course with specific reference to antibiotic use, episode severity, intervention and outcome.


RESULTS
111 consecutive episodes of acute pancreatitis constitute the reported population. 31 (28%) were tertiary transfers. Overall 65 (58.5%) patients received antibiotics. Significantly more tertiary transfer patients received antibiotics. Mean person-days of antibiotic use was 23.9 (sd 29.7) days in the overall study group but there was significantly more use in the tertiary transfer group as compared to patients having their index admission to the centre (40.9 sd 37.1 vs 10.2 sd 8.9; P < 0.005). Thirty four (44%) of patients with clinically mild acute pancreatitis received antibiotics.


CONCLUSIONS
There is substantial use of antibiotics in acute pancreatitis, in particular in patients with severe disease. Over-use is seen in mild acute pancreatitis. Better consideration must be given to identification of prophylaxis or therapy as indication. In relation to repeated courses of antibiotics in severe disease there must be clear indications for use.
Regional Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, Manchester, UK.
Minas
M
Baltatzis
Warwick Medical School, University of Warwick, Coventry, England, UK.
J M
JM
Mason
Regional Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, Manchester, UK.
Vishnu
V
Chandrabalan
Regional Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, Manchester, UK.
Panagiotis
P
Stathakis
Pharmacy Dept, Manchester Royal Infirmary, Manchester, UK.
Ben
B
McIntyre
Regional Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, Manchester, UK.
Santhalingam
S
Jegatheeswaran
Regional Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, Manchester, UK.
Saurabh
S
Jamdar
Regional Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, Manchester, UK; University of Manchester, Faculty of Medical and Human Sciences, Manchester, England, UK.
Derek A
DA
O'Reilly
Regional Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, Manchester, UK; University of Manchester, Faculty of Medical and Human Sciences, Manchester, England, UK. Electronic address: ajith.siriwardena@cmft.nhs.uk.
Ajith K
AK
Siriwardena
D000208:Acute Disease; D061605:Administration, Intravenous; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D004363:Drug Utilization / Q000706:statistics & numerical data; D004724:Endoscopy; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D057970:Inappropriate Prescribing; D008279:Magnetic Resonance Imaging; D008297:Male; D010195:Pancreatitis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery; D019283:Pancreatitis, Acute Necrotizing / Q000188:drug therapy / Q000601:surgery; D010360:Patient Transfer; D062606:Tertiary Care Centers; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents
Acute pancreatitis; Antbiotic resistance; Antibiotic therapy; Antiobiotic prophylaxis