In the 1970s, three small randomized studies of prophylactic
ampicillin in the treatment of
acute pancreatitis showed no effect on mortality or morbidity, but the inclusion of patients at low risk for
infection and the use of an ineffective
antibiotic were insufficient to detect any differences. From 1993 to 2001, eight prospective clinical trials of
antibiotic prophylaxis were conducted in patients with severe
acute pancreatitis (SAP). Seven of the 8 trials showed significant effect of the prophylaxis in prevention of pancreatic
infections, and one showed significant improvement of
clinical course documented by the Acute Physiology and Chronic Health Evaluation II (APACHE II) scores. Only two trials did demonstrate the significance of the prophylaxis in lowering the mortality rate. Despite variations in
drug agents, study size and patient selection,
duration of treatment, and methodology (None of the studies was double-blinded), a meta-analysis showed the positive effect of
antibiotics in reducing the mortality. We suggested that
antibiotic prophylaxis with proven efficacy in necrotic pancreatic tissues should be given to all patients with
acute necrotizing pancreatitis. In recent years, however, the first double-blind, placebo-controlled multicenter study from Germany detected no benefit of
antibiotic prophylaxis with respect to the risk of developing infected
pancreatic necrosis.
CONCLUSION: