Antibiotic therapy in acute pancreatitis: From global overuse to evidence based recommendations.

Abstract

BACKGROUND:

Unwarranted administration of antibiotics in acute pancreatitis presents a global challenge. The clinical reasoning behind the misuse is poorly understood. Our aim was to investigate current clinical practices and develop recommendations that guide clinicians in prescribing antibiotic treatment in acute pancreatitis.

METHODS:

Four methods were used. 1) Systematic data collection was performed to summarize current evidence; 2) a retrospective questionnaire was developed to understand the current global clinical practice; 3) five years of prospectively collected data were analysed to identify the clinical parameters used by medical teams in the decision making process, and finally; 4) the UpToDate Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was applied to provide evidence based recommendations for healthcare professionals.

RESULTS:

The systematic literature search revealed no consensus on the start of AB therapy in patients with no bacterial culture test. Retrospective data collection on 9728 patients from 22 countries indicated a wide range (31-82%) of antibiotic use frequency in AP. Analysis of 56 variables from 962 patients showed that clinicians initiate antibiotic therapy based on increased WBC and/or elevated CRP, lipase and amylase levels. The above mentioned four laboratory parameters showed no association with infection in the early phase of acute pancreatitis. Instead, procalcitonin levels proved to be a better biomarker of early infection. Patients with suspected infection because of fever had no benefit from antibiotic therapy.

CONCLUSIONS:

The authors formulated four consensus statements to urge reduction of unjustified antibiotic treatment in acute pancreatitis and to use procalcitonin rather than WBC or CRP as biomarkers to guide decision-making.

• Authors: Andrea Párniczky, Tamás Lantos, Eszter Margit Tóth, Zsolt Szakács, Szilárd Gódi, Roland Hágendorn, Dóra Illés, Balázs Koncz, Katalin Márta, Alexandra Mikó, Dóra Mosztbacher, Balázs Csaba Németh, Dániel Pécsi, Anikó Szabó, Ákos Szücs, Péter Varjú, Andrea Szentesi, Erika Darvasi, Bálint Erőss, Ferenc Izbéki, László Gajdán, Adrienn Halász, Áron Vincze, Imre Szabó, Gabriella Pár, Judit Bajor, Patrícia Sarlós, József Czimmer, József Hamvas, Tamás Takács, Zoltán Szepes, László Czakó, Márta Varga, János Novák, Barnabás Bod, Attila Szepes, János Sümegi, Mária Papp, Csaba Góg, Imola Török, Wei Huang, Qing Xia, Ping Xue, Weiqin Li, Weiwei Chen, Natalia V Shirinskaya, Vladimir L Poluektov, Anna V Shirinskaya, Péter Jenő Hegyi, Marian Bátovský, Juan Armando Rodriguez-Oballe, Isabel Miguel Salas, Javier Lopez-Diaz, J Enrique Dominguez-Munoz, Xavier Molero, Elizabeth Pando, María Lourdes Ruiz-Rebollo, Beatriz Burgueño-Gómez, Yu-Ting Chang, Ming-Chu Chang, Ajay Sud, Danielle Moore, Robert Sutton, Amir Gougol, Georgios I Papachristou, Yaroslav Mykhailovych Susak, Illia Olehovych Tiuliukin, António Pedro Gomes, Maria Jesus Oliveira, David João Aparício, Marcel Tantau, Floreta Kurti, Mila Kovacheva-Slavova, Stephanie-Susanne Stecher, Julia Mayerle, Goran Poropat, Kshaunish Das, Marco Vito Marino, Gabriele Capurso, Ewa Małecka-Panas, Hubert Zatorski, Anita Gasiorowska, Natalia Fabisiak, Piotr Ceranowicz, Beata Kuśnierz-Cabala, Joana Rita Carvalho, Samuel Raimundo Fernandes, Jae Hyuck Chang, Eun Kwang Choi, Jimin Han, Sara Bertilsson, Hanaz Jumaa, Gabriel Sandblom, Sabite Kacar, Minas Baltatzis, Aliaksandr Vladimir Varabei, Vizhynis Yeshy, Serge Chooklin, Andriy Kozachenko, Nikolay Veligotsky, Péter Hegyi, Hungarian Pancreatic Study Group
• Journal: Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] (Pancreatology) Vol. 19 Issue 4 Pg. 488-499 (Jun 2019) ISSN: 1424-3911 [Electronic] Switzerland
• PMID: 31068256 (Publication Type: Journal Article)
• Copyright: Copyright © 2019 IAP and EPC. Published by Elsevier B.V. All rights reserved.

Chemical References

• Anti-Bacterial Agents
• Biomarkers

Topics

• Acute Disease
• Anti-Bacterial Agents (therapeutic use)
• Antimicrobial Stewardship
• Bacterial Infections (complications, drug therapy)
• Biomarkers
• Clinical Decision-Making
• Consensus
• Evidence-Based Medicine
• Guideline Adherence
• Humans
• Pancreatitis (complications, drug therapy, microbiology)
• Practice Patterns, Physicians'
• Randomized Controlled Trials as Topic
• Surveys and Questionnaires