Effect of antibiotic prophylaxis on acute necrotizing pancreatitis: results of a randomized controlled trial.

Abstract

BACKGROUND AND AIMS:

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).

CONCLUSION:

There was no benefit in the outcomes when antibiotic prophylaxis was routinely used in patients with acute necrotizing pancreatitis.

• Authors: Ping Xue, Li-Hui Deng, Zhao-Da Zhang, Xiao-Nan Yang, Mei-Hua Wan, Bing Song, Qing Xia
• Journal: Journal of gastroenterology and hepatology (J Gastroenterol Hepatol) Vol. 24 Issue 5 Pg. 736-42 (May 2009) ISSN: 1440-1746 [Electronic] Australia
• PMID: 19220676 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Bacterial Agents
• Drug Combinations
• Cilastatin
• Imipenem
• C-Reactive Protein
• Cilastatin, Imipenem Drug Combination

Topics

• Adult
• Anti-Bacterial Agents (administration & dosage, adverse effects)
• Antibiotic Prophylaxis (adverse effects)
• C-Reactive Protein (metabolism)
• Cilastatin (administration & dosage, adverse effects)
• Cilastatin, Imipenem Drug Combination
• Disease Progression
• Drug Combinations
• Female
• Humans
• Imipenem (administration & dosage, adverse effects)
• Male
• Middle Aged
• Mycoses (chemically induced)
• Pancreas (diagnostic imaging, drug effects, surgery)
• Pancreatectomy
• Pancreatitis (complications, diagnostic imaging, drug therapy, mortality, surgery)
• Pancreatitis, Acute Necrotizing (diagnostic imaging, etiology, pathology, prevention & control, surgery)
• Patient Selection
• Severity of Illness Index
• Time Factors
• Tomography, X-Ray Computed
• Treatment Outcome