Abstract
Background and objectiveThe use of antibiotics in acute pancreatitis despite recent clinical trials remains controversial. The aim of this study is to review the latest clinical trials and guidelines about antibiotics in acute pancreatitis and determine its proper use.MethodsThrough a Medline search, we selected and analyzed pertinent randomized clinical trials and guidelines that evaluated the use of antibiotics in acute pancreatitis. We answered the most frequent questions about this topic.Results and conclusionBased on these clinical trials and guidelines, we conclude that the best treatment currently is the use of antibiotics in patients with severe acute pancreatitis with more than 30% of pancreatic necrosis. The best option for the treatment is Imipenem 3 × 500 mg/day i.v. for 14 days. Alternatively, Ciprofloxacin 2 × 400 mg/day i.v. associated with Metronidazole 3 × 500 mg for 14 days can also be considered as an option.
Highlights
Background and objectiveThe use of antibiotics in acute pancreatitis despite recent clinical trials remains controversial
acute pancreatitis (AP) develops in two phases: the first ten days are characterized by the systemic inflammatory response syndrome (SIRS), whereas in the end of the second week infection complications begin to appear [2]
The Cochrane review about the use of antibiotics in AP concluded that despite variations in drug agent, duration of treatment and methodological quality of clinical trials, there is strong evidence that intravenous antibiotic prophylactic therapy for 10 to 14 days decrease the risk of superinfection of necrotic tissue and mortality in patients with Severe acute pancreatitis (SAP) with proven pancreatic necrosis at CT [37]
Summary
Based on these clinical trials and guidelines, we conclude that the best treatment currently is the use of antibiotics in patients with severe acute pancreatitis with more than 30% of pancreatic necrosis. The Cochrane review about the use of antibiotics in AP concluded that despite variations in drug agent, duration of treatment and methodological quality of clinical trials, there is strong evidence that intravenous antibiotic prophylactic therapy for 10 to 14 days decrease the risk of superinfection of necrotic tissue and mortality in patients with SAP with proven pancreatic necrosis at CT [37]. There are evidences in the literature that fungal infection has to be considered as an additional factor which influences the outcome of the patients [29] Based on these studies we believe that the use of antibiotics is benefic to patients with SAP with more than 30% pancreatic necrosis, and starting as soon as possible. We should not wait for them to make a decision in the treatment of these patients
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