OBJECTIVES: The use of prophylactic antibiotics in severe acute pancreatitis (SAP) is controversial. The aim of this study was to compare the effects of antibiotics administered as prophylaxis and as treatment on demand, respectively, in two prospective, non-randomized cohorts of patients. METHODS: The study population consisted of 210 patients treated for SAP. In Group 1 (n= 103), patients received prophylactic antibiotics (ciprofloxacin, metronidazole). In Group 2 (n= 107), patients were treated on demand. Ultrasound-guided drainage and/or surgical debridement of infected necrosis were performed when the presence of infected pancreatic necrosis was demonstrated. The primary endpoints were infectious complication rate, need for and timing of surgical interventions, incidence of nosocomial infections and mortality rate. RESULTS: Ultrasound-guided fine needle aspiration [in 18 (16.8%) vs. 13 (12.6%) patients; P= 0.714], ultrasound-guided drainage [in 15 (14.0%) vs. six (5.8%) patients; P= 0.065] and open surgical necrosectomy [in 10 (9.3%) vs. five (4.9%) patients; P= 0.206] were performed more frequently and earlier [at 16.6 ± 7.8 days vs. 17.2 ± 6.7 days (P= 0.723); at 19.5 ± 9.4 days vs. 24.5 ± 14.2 days (P= 0.498), and at 22.6 ± 13.5 days vs. 26.7 ± 18.1 days (P= 0.826), respectively] in Group 2 compared with Group 1. There were no significant differences between groups in mortality and duration of stay in the surgical ward or intensive care unit. CONCLUSIONS: The results of this study support the suggestion that the use of prophylactic antibiotics does not affect mortality rate, but may decrease the need for interventional and surgical management, and lower the number of reoperations.
OBJECTIVES: The use of prophylactic antibiotics in severe acute pancreatitis (SAP) is controversial. The aim of this study was to compare the effects of antibiotics administered as prophylaxis and as treatment on demand, respectively, in two prospective, non-randomized cohorts of patients. METHODS: The study population consisted of 210 patients treated for SAP. In Group 1 (n= 103), patients received prophylactic antibiotics (ciprofloxacin, metronidazole). In Group 2 (n= 107), patients were treated on demand. Ultrasound-guided drainage and/or surgical debridement of infected necrosis were performed when the presence of infected pancreatic necrosis was demonstrated. The primary endpoints were infectious complication rate, need for and timing of surgical interventions, incidence of nosocomial infections and mortality rate. RESULTS: Ultrasound-guided fine needle aspiration [in 18 (16.8%) vs. 13 (12.6%) patients; P= 0.714], ultrasound-guided drainage [in 15 (14.0%) vs. six (5.8%) patients; P= 0.065] and open surgical necrosectomy [in 10 (9.3%) vs. five (4.9%) patients; P= 0.206] were performed more frequently and earlier [at 16.6 ± 7.8 days vs. 17.2 ± 6.7 days (P= 0.723); at 19.5 ± 9.4 days vs. 24.5 ± 14.2 days (P= 0.498), and at 22.6 ± 13.5 days vs. 26.7 ± 18.1 days (P= 0.826), respectively] in Group 2 compared with Group 1. There were no significant differences between groups in mortality and duration of stay in the surgical ward or intensive care unit. CONCLUSIONS: The results of this study support the suggestion that the use of prophylactic antibiotics does not affect mortality rate, but may decrease the need for interventional and surgical management, and lower the number of reoperations.
Authors: Hjalmar C van Santvoort; Marc G Besselink; Olaf J Bakker; H Sijbrand Hofker; Marja A Boermeester; Cornelis H Dejong; Harry van Goor; Alexander F Schaapherder; Casper H van Eijck; Thomas L Bollen; Bert van Ramshorst; Vincent B Nieuwenhuijs; Robin Timmer; Johan S Laméris; Philip M Kruyt; Eric R Manusama; Erwin van der Harst; George P van der Schelling; Tom Karsten; Eric J Hesselink; Cornelis J van Laarhoven; Camiel Rosman; Koop Bosscha; Ralph J de Wit; Alexander P Houdijk; Maarten S van Leeuwen; Erik Buskens; Hein G Gooszen Journal: N Engl J Med Date: 2010-04-22 Impact factor: 91.245
Authors: C Bassi; M Falconi; G Talamini; G Uomo; G Papaccio; C Dervenis; R Salvia; E B Minelli; P Pederzoli Journal: Gastroenterology Date: 1998-12 Impact factor: 22.682
Authors: Cheryl Li Ling Lim; Winnie Lee; Yi Xin Liew; Sarah Si Lin Tang; Maciej Piotr Chlebicki; Andrea Lay-Hoon Kwa Journal: J Gastrointest Surg Date: 2015-01-22 Impact factor: 3.452
Authors: Viktoria Hentschel; Benjamin Walter; Noemi Harder; Frank Arnold; Thomas Seufferlein; Martin Wagner; Martin Müller; Alexander Kleger Journal: Antibiotics (Basel) Date: 2022-03-21