The Role of Antibiotic Prophylaxis in the Treatment of Acute Pancreatitis

Abstract

Acute pancreatitis is an inflammatory disorder, but it is not generally caused by infectious agents. Yet, in tertiary referral hospitals, the majority of patients who die of necrotizing pancreatitis do so as a consequence of infectious complications. These generally develop late (2-4 weeks) in the disease process. This finding prompted the hypothesis that infectious pancreatitis complications, such as an abscess or an infected necrosis which can lead to death, can be reduced by treating patients who suffer, at least initially, from a sterile inflammatory disorder, with broad-spectrum antibiotics. Here we review the experimental foundations of this hypothesis, as well as the difficulties that were encountered when clinical trials were undertaken to confirm it. At present, there is still a case for treating necrotizing pancreatitis patients with broad-spectrum antibiotics (specifically carbapenems), but the extent of the beneficial effect and the number of patients expected to profit from this approach should not be overestimated.