Antibiotic prophylaxis in large pancreatic necrosis: multicenter randomized trial with ciprofloxacin and metronidazole or meropenem.

The prognosis of patients with acute necrotizing pancreatitis is mostly influenced by infection, thus the role of prophylaxis of infectious complications in severe acute pancreatitis (SAP) still remains a debatable issue.

AIM:

The aim of the study was to assess the efficacy of prophylactic antibiotic treatment comparing rates of infectious complications, mean hospital stay, necessity of surgical treatment and mortality in two groups of patients with large pancreatic necrosis in SAP.

METHODS:

Thirty five patients with SAP with CT or/and autopsy verified large pancreatic necrosis (> 30% of pancreatic tissue) were enrolled into the study. The patients were randomized either into the prophylactic (P) or into the therapeutic (T) group. In the P-group, ciprofloxacin (200 mg BID) and metronidazol (500 mg TID) or meropenem (500 mg TID) was administrated for 10 days. In the T-group, the patients received the same antibiotics only in the case of confirmed infectious complications (infected necrosis, abscess, urinary infection, pneumonia, etc.). Results are summarized in the table.

CONCLUSIONS:

Neither the rate of infectious complications nor mortality were reduced significantly by prophylactic antibiotic treatment in patients with large pancreatic necrosis.