Abstract
Recent controlled clinical studies suggest a positive effect of early antibiotic treatment on late morbidity and mortality in severe acute pancreatitis. In contrast, widespread use of antibiotics may lead to an increased number of fungal infections and multiresistant bacteria. Optimal choice, duration, and route of administration of the antibiotic agent(s) are far from being established. The additional administration of an antifungal agent with prophylactic intention cannot be supported by the currently available data.
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References and Recommended Reading
British Society of Gastroenterology: United Kingdom guidelines for the management of acute pancreatitis. Gut 1998, 42:S1-S13.
Uhl W, Büchler MW, Malfertheiner P, et al.: A randomized, double blind, multicenter trial of Octreotide in moderate to severe acute pancreatitis. Gut 1999, 45:97–104.
Gloor B, Müller AC, Worni M, et al.: Pancreatic infection in severe pancreatitis: the role of fungus and multi-resistant organisms. Arch Surg 2001, in press.
Norman J: The role of cytokines in the pathogenesis of acute pancreatitis. Am J Surg 1998, 175:76–83. Important summary of the pathogenesis that takes into consideration the role of inflammatory mediators.
Gloor B, Reber HA: Effects of cytokines and other inflammatory mediators on human acute pancreatitis. J Int Care Med 1998, 13:305–312.
Osman MO, Jensen SL: Acute pancreatitis: the pathophysiological role of cytokines and integrins. Dig Surg 1999, 16:347–362. Comprehensive update on the topic.
Büchler M, Malfertheiner P, Schadlich H, et al.: Role of phospholipase A2 in human acute pancreatitis. Gastroenterology 1989, 97:1521–1526.
Bradley EL: A clinically based classification system for acute pancreatitis: summary of the International Symposium on Acute Pancreatitis, Atlanta, GA, September 11 through 13, 1992. Arch Surg 1993, 128:586–590.
Büchler MW, Gloor B, Müller CA, et al.: Acute necrotizing pancreatitis: treatment strategy according to the status of infection. Ann Surg 2000, 232:619–626. Report from a large single-center trial using infection as the primary indication for surgery and treating sterile necrosis nonoperatively.
Beger HG, Krautzberger W, Bittner R, et al.: Results of surgical treatment of necrotizing pancreatitis. World J Surg 1985, 9:972–979.
Beger HG, Bittner R, Block S, Büchler M: Bacterial contamination of pancreatic necrosis: a prospective clinical study. Gastroenterology 1986, 91:433–438.
Fernandez-del Castillo C, Rattner DW, Makary MA, et al.: Debridement and closed packing for the treatment of necrotizing pancreatitis. Ann Surg 1998, 228:676–684.
McFadden DW, Reber HA: Indications for surgery in severe acute pancreatitis. Int J Pancreatol 1994, 15:83–90.
Isenmann R, Beger HG: Natural history of acute pancreatitis and the role of infection. Baillieres Best Pract Res Clin Gastroenterol 1999, 13:291–301.
Gerzof SG, Banks PA, Robbins AH, et al.: Early diagnosis of pancreatic infection by computed tomography-guided aspiration. Gastroenterology 1987, 93:1315–1320.
Schmid SW, Uhl W, Friess H, et al.: The role of infection in acute pancreatitis. Gut 1999, 45:311–316.
Isenmann R, Rau B, Beger HG: Bacterial infection and extent of necrosis are determinants of organ failure in patients with acute necrotizing pancreatitis. Br J Surg 1999, 86:1020–1024.
Craig RM, Dordal E, Myles L: The use of ampicillin in acute pancreatitis [letter]. Ann Intern Med 1975, 83:831–832.
Howes R, Zuidema GD, Cameron JL: Evaluation of prophylactic antibiotics in acute pancreatitis. J Surg Res 1975, 18:197–200.
Finch WT, Sawyers JL, Schenker S: A prospective study to determine the efficacy of antibiotics in acute pancreatitis. Ann Surg 1976, 183:667–671.
Büchler M, Malfertheiner P, Friess H, et al.: Human pancreatic tissue concentration of bactericidal antibiotics. Gastroenterology 1992, 103:1902–1908.
Powell JJ, Miles R., Siriwardena AK: Antibiotic prophylaxis in the initial management of severe acute pancreatitis. Br J Surg 1998, 85:582–587.
Ratschko M, Fenner T, Lankisch PG: The role of antibiotic prophylaxis in the treatment of acute pancreatitis. Gastroenterol Clin North Am 1999, 28:641–659.
Kramer KM, Levy H: Prophylactic antibiotics for severe acute pancreatitis: the beginning of an era. Pharmacotherapy 1999, 19:592–602.
Gumaste VV: Prophylactic antibiotic therapy in the management of acute pancreatitis. J Clin Gastroenterol 2000, 31:6–10.
Widdison AL, Karanjia ND, Reber HA: Antimicrobial treatment of pancreatic infection in cats. Br J Surg 1994, 81:886–889.
Araida T, Frey CF, Ruebner B, et al.: Therapeutic regimens in acute experimental pancreatitis in rats: effects of a protease inhibitor, a beta-agonist, and antibiotics. Pancreas 1995, 11:132–140.
Foitzik T, Fernandez-del Castillo C, Ferraro MJ, et al.: Pathogenesis and prevention of early pancreatic infection in experimental acute necrotizing pancreatitis. Ann Surg 1995, 222:179–185.
Mithöfer K, Fernandez-del Castillo C, Ferraro MJ, et al.: Antibiotic treatment improves survival in experimental acute necrotizing pancreatitis. Gastroenterology 1996, 110:232–240.
Hayashi J, Kawarada Y, Isaji S, et al.: Therapeutic effects of continuous intraarterial antibiotic infusion in preventing pancreatic infection in experimental acute necrotizing pancreatitis. Pancreas 1996, 13:184–192.
Pederzoli P, Bassi C, Vesentini S, Campedelli A: A randomized multicenter clinical trial of antibiotic prophylaxis of septic complications in acute necrotizing pancreatitis with imipenem. Surg Gynecol Obstet 1993, 176:480–483.
Sainio V, Kemppainen E, Puolakkainen P, et al.: Early antibiotic treatment in acute necrotising pancreatitis. Lancet 1995, 346:663–667.
Luiten EJ, Hop WC, Lange JF, Bruining HA: Controlled clinical trial of selective decontamination for the treatment of severe acute pancreatitis. Ann Surg 1995, 222:57–65. Important contribution using a different approach for administering antibiotics.
Delcenserie R, Yzet T, Ducroix JP:Prophylactic antibiotics in treatment of severe acute alcoholic pancreatitis. Pancreas 1996, 13:198–201.
Schwarz M, Isenmann R, Meyer H, Beger HG: Antibiotic use in necrotizing pancreatitis: results of a controlled study. Dtsch Med Wochenschr 1997, 122:356–361.
Bassi C, Falconi M, Talamini G, et al.: Controlled clinical trial of pefloxacin versus imipenem in severe acute pancreatitis. Gastroenterology 1998, 115:1513–1517.
Takeda K, Sunamura M, Shibuya K, et al.: Role of early continuous regional arterial infusion of protease inhibitor and antibiotic in nonsurgical treatment of acute necrotizing pancreatitis. Digestion 1999, 60:9–13.
Golub R, Siddiqi F, Pohl D: Role of antibiotics in acute pancreatitis: a meta-analysis. J Gastrointest Surg 1998, 2:496–503. Important meta-analysis circumventing the problem of small patient numbers in individual studies.
Luiten EJ, Hop WC, Lange JF, Bruining HA: Differential prognosis of gram-negative versus gram-positive infected and sterile pancreatic necrosis: results of a randomized trial in patients with severe acute pancreatitis treated with adjuvant selective decontamination. Clin Infect Dis 1997, 25:811–816.
Hoerauf A, Hammer S, Muller-Myhsok B, Rupprecht H: Intra-abdominal Candida infection during acute necrotizing pancreatitis has a high prevalence and is associated with increased mortality. Crit Care Med 1998, 26:2010–2015.
Grewe M, Tsiotos GG, Luque de-Leon E, Sarr MG: Fungal infection in acute necrotizing pancreatitis. J Am Coll Surg 1999, 188:408–414. Large series providing detailed information on risk factors for and time point of fungal infection.
Aloia T, Solomkin J, Fink AS, et al.: Candida in pancreatic infection: a clinical experience. Am Surg 1994, 60:793–796.
Götzinger P, Wamser P, Barlan M, et al.: Candida infection of local necrosis in severe acute pancreatitis is associated with increased mortality. Shock 2000, 14:320–324.
Lange JF, van Gool J, Tytgat GN: The protective effect of a reduction in intestinal flora on mortality of acute haemorrhagic pancreatitis in the rat. Hepatogastroenterology 1987, 34:28–30.
Isaji S, Suzuki M, Frey CF, et al.: Role of bacterial infection in diet-induced acute pancreatitis in mice. Int J Pancreatol 1992, 11:49–57.
Marotta F, Geng TC, Wu CC, Barbi G: Bacterial translocation in the course of acute pancreatitis: beneficial role of nonabsorbable antibiotics and lactitol enemas. Digestion 1996, 57:446–452.
Isenmann R, Schwarz M, Rau B, et al.: Candida in patients with infected necrosis: a sequel of prior antibiotic treatment [abstract]. Digestion 2000, 62:268.
Tenner S, Sica G, Hughes M, et al.: Relationship of necrosis to organ failure in severe acute pancreatitis. Gastroenterology 1997, 113:899–903.
Ho HS, Frey CF: The role of antibiotic prophylaxis in severe acute pancreatitis. Arch Surg 1997, 132:487–493.
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Beat, G., Oliver, S., Waldemar, U. et al. Prophylactic antibiotics and pancreatic necrosis. Curr Gastroenterol Rep 3, 109–114 (2001). https://doi.org/10.1007/s11894-001-0006-7
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DOI: https://doi.org/10.1007/s11894-001-0006-7