Abstract | OBJECTIVE: DATA SOURCES: A search of PubMed (1998-July 2009) was conducted using the terms necrotizing pancreatitis, antibiotics, prophylaxis, and treatment. Clinical studies, meta-analyses, and review articles published in English were included. Additional references were obtained from article bibliographies. Randomized trials published before 1998 were included if indicated. STUDY SELECTION AND DATA EXTRACTION: Relevant studies or meta-analyses on antibiotic prophylaxis since our previous review in 1998 were evaluated; older data were included if still relevant. DATA SYNTHESIS: Since our previous review, 4 more randomized trials, including 2 double-blind trials, have been conducted. The blinded studies found no significant difference in mortality with antibiotic prophylaxis compared with placebo, while the unblinded studies found a significant decrease in infections. Given these disparate results, available guidelines and meta-analyses provide different conclusions, usually based on exclusion or inclusion of a single trial. Based on all available data, antibiotic prophylaxis should not be used in patients with necrotizing pancreatitis. Instead, a more measured, on-demand use of antibiotics is preferred. Antibiotics should be added if signs and symptoms of infection are present (eg, fever, leukocytosis, positive results of cultures). Given improvements in intensive care and nutritional support, recent trials have found a lower incidence of infected necrotizing pancreatitis than before. Therefore, future trials are likely to need higher numbers of patients. CONCLUSIONS:
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Authors | Marisel Segarra-Newnham, Augustus Hough |
Journal | The Annals of pharmacotherapy
(Ann Pharmacother)
Vol. 43
Issue 9
Pg. 1486-95
(Sep 2009)
ISSN: 1542-6270 [Electronic] United States |
PMID | 19690227
(Publication Type: Journal Article, Review)
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Chemical References |
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Topics |
- Anti-Bacterial Agents
(therapeutic use)
- Antibiotic Prophylaxis
(methods)
- Disease Progression
- Humans
- Pancreatitis, Acute Necrotizing
(complications, drug therapy)
- Randomized Controlled Trials as Topic
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