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Primary study

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Journal Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
Year 2009
Background: The use of prophylactic antibiotics in acute severe necrotizing pancreatitis is controversial. Methods: Prospective, randomized, placebo-controlled, double-blind study was carried out at Bellvitge Hospital, in Barcelona, Spain. Among 229 diagnosed with severe acute pancreatitis, 80 had evidence of necrotizing pancreatitis (34/80 patients were excluded of the protocol). Forty-six patients without previous antibiotic treatment with pancreatic necrosis in a contrast-enhanced CT scan were randomly assigned to receive either intravenous ciprofloxacin or placebo. Five patients were secondarily excluded, and the remaining 41 patients were finally included in the study (22 patients received intravenous ciprofloxacin and 19 patients placebo). Results: Comparing the 22 with intravenous ciprofloxacin and 19 with placebo, infected pancreatic necrosis was detected in 36% and 42% respectively (p∈=∈0.7). The mortality rate was 18% and 11%, respectively (p∈=∈0.6). No significant differences between both treatment groups were observed with respect to variables such as: non-pancreatic infections, surgical treatment, timing and the re-operation rate, organ failure, length of hospital and ICU stays. Conclusion: The prophylactic use of ciprofloxacin in patients with severe necrotizing pancreatitis did not significantly reduce the risk of developing pancreatic infection or decrease the mortality rate. The small number of patients included in this study should be considered. © 2008 The Society for Surgery of the Alimentary Tract.

Primary study

Unclassified

Journal Acta gastroenterologica Latinoamericana
Year 2009
Objetive: to evaluate the capacity of Imipenem as a prophylactic treatment for decreasing the number of infected necrosis and surgeries, as well as for diminishing septic complications and the mortality rate among patients with severe acute necrotizing pancreatitis. Mterial and Methods: from May 2005 to December 2007 a prospective randomized study was conducted in order to evaluate the efficacy of a prophylactic antibiotic therapy in patients with pancreatic necrosis. During this time period 58 patients entered the study protocol. Patients were divided in two groups; the first one underwent antibiotic therapy with Imipenem while the second group received no prophylactic treatment at all. All patients received early enteral nutrition. Results: both studied groups had comparable age, gender ratio, and C.R.P. and necrosis percentages. When comparing general morbidity in both groups no difference was found between the group receiving a prophylactic antibiotic and the group that did not receive it (58% vs. 56%). Moreover, when the septic complications were evaluated, it was confirmed that these were more frequent among the group of patients receiving Imipenem (29%), in comparison to the group that did not received antibiotics (15%). 12.5% of the patients that received Imipenem developed pancreatic necrosis infection, while said infection only appeared in 6% of the patients in the group that did not receive antibiotic prophylaxis; nevertheless, none of the comparisons reached statistical significance. The number of patients who required surgery was similar in both groups. When comparing the hospital stay, it was observed that this was longer among the patients receiving prophylactic therapy. No patient died during the study. Conclusion: The present study finds no benefits in the use of antibiotic therapy with Imipenem regarding the risk of developing pancreatic necrosis infection and septic complications, and neither when trying to reduce the number of surgeries among patients with severe acute pancreatitis with necrosis.

Primary study

Unclassified

Authors Xue P , Deng LH , Zhang ZD , Yang XN , Wan MH , Song B , Xia Q
Journal Journal of gastroenterology and hepatology
Year 2009
Background and Aims: This study addresses whether antibiotic prophylaxis is beneficial for acute necrotizing pancreatitis. Methods: This randomized, controlled trial enrolled 276 patients with severe acute pancreatitis. There were 56 patients with 30% or more necrosis proved by contrast-enhanced computerized tomography who were eligible for randomization: 29 in the study group and 27 in the control group, who received i.v. imipenem-cilastatin (3 × 500 mg/day) within 72 h of the onset of symptoms for 7-14 days, and no antibiotic prophylaxis, respectively. The primary end-point was the incidence of infectious complication. The secondary end-points were mortality, the incidence of necrosectomy for infected necrosis, the incidence of organ complication and hospital courses. Results: Characteristics of baseline data were similar in the two groups. No significant differences were found in the incidence of infected pancreatic necrosis (37% vs 27.6%), mortality (10.3% vs 14.8%) and the incidence of operative necrosectomy (29.6% vs 34.6%) between the study group and the control group (P > 0.05). The incidence of extrapancreatic infections, organ complications and hospital courses between the groups were also not significantly different. However, a significantly increased incidence of fungal infection was observed in the study group versus the control group (36.1% vs 14.2%, P < 0.05). Conclusion: There was no benefit in the outcomes when antibiotic prophylaxis was routinely used in patients with acute necrotizing pancreatitis. © 2009 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd.

Primary study

Unclassified

Authors Yang XN , Deng LH , Xue P , Zhao L , Jin T , Wan MH , Xia Q
Journal Zhong xi yi jie he xue bao = Journal of Chinese integrative medicine
Year 2009
Objective: To investigate the prognostic effects of integrated traditional Chinese and Western medicine therapy without antibiotics in treatment of patients with severe acute pancreatitis (SAP). Methods: SAP patients were randomly divided into treatment group (26 cases included) and control group (28 cases included). In addition to the same protocol of integrated traditional Chinese and Western medicine treatment for both groups, intravenous drip infusion of 0.5 g imipenem-cilastatin was administered to the patients in the control group every eight hours for ten days. The 48-hour Ranson score, 24-hour acute physiology and chronic heath evaluation II score, and incidence rates of complications were observed. The concentrations of serum C-reactive protein (CRP) on days 1, 3, 7 and 10 were measured, and strains of infection were detected with smear and culture examination for bacteria and fungi. Results: There were no statistical differences in demographic information, baseline-data and incidence rates of complications between the two groups (P>0.05), but fungal infection rate in the control group was higher than that in the treatment group (P<0.05). There were no statistical differences in infection rates of G- and G+ germs between the two groups; blood and some organs including lung, pancreas, intestine, and urethra were infected with bacteria and fungi. There were also no significant differences in the serum CRP concentrations on days 1, 3, 7 and 10 between the two groups (P>0.05), but the serum CRP concentrations on days 1, 3, 7 and 10 in infected patients were higher than those in non-infected patients (P<0.05, P<0.01). Conclusion: The study cannot confirm that the incidence rates of secondary infection and mortality in SAP patients treated with integrated traditional Chinese and Western medicine are reduced by prophylaxis with imipenem-cilastatin.

Primary study

Unclassified

Journal Scandinavian journal of gastroenterology
Year 2007
OBJECTIVE: The main causes of death in severe pancreatitis are multiorgan failure and septic complications. Prophylactic treatment with effective antibiotics is therefore a tempting therapeutic option. However, there could be side effects such as selection of resistant microbes and fungi. The aim of the present study was to compare the rate of infectious complications, interventions, days in the intensive care unit (ICU), morbidity and mortality in patients with severe pancreatitis randomized to prophylactic therapy with imipenem compared with those receiving no treatment at all. MATERIAL AND METHODS: Seventy-three patients with severe pancreatitis were included in a prospective, randomized, clinical study in seven Norwegian hospitals. The number of patients was limited to 73 because of slow patient accrual. Severe pancreatitis was defined as a C-reactive protein (CRP) level of >120 mg/l after 24 h or CRP >200 48 h after the start of symptoms. The patients were randomized to either early antibiotic treatment (imipenem 0.5 g x 3 for 5-7 days) (imipenem group) (n=36) or no antibiotics (control group) (n=37). RESULTS: The groups were similar in age, cause of pancreatitis, duration of symptoms and APACHE II score. Patients in the imipenem group experienced lower rates of complications (12 versus 22 patients) (p=0.035) and infections (5 versus 16 patients) (p=0.009) than those in the control group. There was no difference in length of hospital stay (18 versus 22 days), need of intensive care (8 versus 7 patients), need of acute interventions (10 versus 13), nor for surgery (3 versus 3) or 30-day mortality rates (3 versus 4). CONCLUSIONS: The study, although underpowered, supports the use of early prophylactic treatment with imipenem in order to reduce the rate of septic complications in patients with severe pancreatitis.

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Primary study

Unclassified

Journal Gastroenterology
Year 2004
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.

Publication Thread

This thread includes 3 references

Publication Thread

This thread includes 2 references

Publication Thread

This thread includes 3 references