TH2.1 Antibiotics during Pancreatitis… Is it “NICE”??

Abstract

Abstract Aim National Institute for Health and Care Excellence (NICE), British Society of Gastroenterology, the American College of Gastroenterology and the trust guidelines do not recommend prophylactic antibiotics in patients with uncomplicated acute pancreatitis. Our three-cycle study was focused on finding out adherence to these guidelines. Method Three cycles of the study were conducted over a span of 2 years with 87, 78 and 121 patients with the peak age range of 20–40 in the first, 41–60 in the others respectively. Unspecified acute pancreatitis and gallstone pancreatitis were the most common diagnosis in the second and third cycles respectively. Majority of patients were prescribed antibiotics on 1–2 days after admission in the first and second cycle and on the day of admission in the third cycle. Results 44.8%, 39.7%, 35.5% of the patients admitted with pancreatitis were prescribed antibiotics in the three cycles respectively. Interestingly, in the first cycle 74.3% patients were prescribed antibiotics without any clear indication. However, we saw an improvement in the trend of prescribing antibiotics without indication from 45% in the second cycle to 37.2% in the last cycle. The maximum number of patients had a hospital stay of 2–4 days in all the cycles. Co-amoxiclav was the most prescribed antibiotic in the first and the third cycle. In the second cycle, the order was Metronidazole followed by Amoxicillin. Conclusion The prescription of empirical antibiotics in acute pancreatitis doesn't improve the duration or outcome of the disease. Therefore, antibiotics must be used judiciously in this era of ever-increasing antibiotic- resistant microbes.