Skip to main content
SpringerLink
Log in

Antibiotic prophylaxis of pancreatic infection in patients with necrotizing pancreatitis: Rationale, evidence, and recommendations

  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

Infectious complications are the most common cause of morbidity and mortality in patients suffering from severe acute pancreatitis. Approximately 25% of patients develop pancreatic necrosis. In these patients with severe disease complicated by necrosis, there is evidence that preventing infection of the pancreatic necrosis decreases morbidity and mortality. Whereas sterile necrosis is often treated conservatively, surgical debridement is required when the necrosis becomes infected. Although surgery is necessary in patients with infected necrosis, for a variety of reasons surgical intervention increases the morbidity and mortality of the disease. Preventing infectious complications, such as infected necrosis, through the use of prophylactic antibiotics is controversial. Despite reviewing the same evidence, different authors and organizations have formed different conclusions. In this review, we perform a critical analysis of the studies. Overall, the use of antibiotics in patients with necrotizing pancreatitis appears to decrease infectious complications and mortality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Steinberg W, Tenner SM: Acute pancreatitis. N Engl J Med 1994, 28:1198–210.

    Article  Google Scholar 

  2. Tenner S: Initial management of acute pancreatitis: critical issues during the first 72 hours. Am J Gastroenterol 2004, 99:2489–2494. This review describes a practical approach to patients with acute pancreatitis. Issues regarding initial intravenous hydration, early endoscopic retrograde cholangiopancreatography, and methods of providing nutrition and preventing pancreatic and infected necrosis are described.

    Article  PubMed  Google Scholar 

  3. Renner IG, Savage WT III, Pantoja JL, et al.: Death due to acute pancreatitis. A retrospective analysis of 405 autopsy cases. Dig Dis Sci 1985, 30:1005–1018.

    Article  PubMed  CAS  Google Scholar 

  4. Mann DV, Hershman MJ, Hittinger R, Glazer G: Multicenter audit of death from acute pancreatitis. Br J Surg 1994, 81:890–893.

    Article  PubMed  CAS  Google Scholar 

  5. Widdison AL, Karanjia ND: Pancreatic infection complicating acute pancreatitis. Br J Surg 1993, 80:148–154.

    Article  PubMed  CAS  Google Scholar 

  6. Banks PA: Practice guidelines in acute pancreatitis. Am J Gastroenterol 1997, 92:377–386. These guidelines provide an important basis for the management of patients with acute pancreatitis. As with all practice guidelines in the American Journal of Gastroenterology, this article is required reading for all gastroenterologists.

    PubMed  CAS  Google Scholar 

  7. Machado MC, Monteiro da Cunha JE, Bacchella T, et al.: Acute pancreatic necrosis in chronic alcoholic pancreatitis. Dig Dis Sci 1984, 29:709–713.

    Article  PubMed  CAS  Google Scholar 

  8. Brown A: Prophylactic antibiotic use in severe acute pancreatitis: hemlock, help or hype. Gastroenterology 2004, 126:1195–1198.

    Article  PubMed  CAS  Google Scholar 

  9. Bassi C, Larvin M, Villatoro E: Antibiotic therapy for prophylaxis against infection of pancreatic necrosis in acute pancreatitis. Cochrane Database Syst Rev 2003, 4:CD002941. This article provides a thorough review of all studies that used antibiotic prophylaxis in the treatment of acute pancreatitis. Information regarding the specific trials has been collected and carefully dissected to provide the reader with a thorough analysis.

    PubMed  Google Scholar 

  10. Nathans AB, Curtis JR, Beale RJ, et al.: Management of the critically ill patient with severe acute pancreatitis. Crit Care Med 2004, 32:2524–2536.

    Article  Google Scholar 

  11. Tarpila E, Nystrom PO, Franzen L, et al.: Bacterial translocation during acute pancreatitis in rats. Eur J Surg 1993, 159:109–113.

    PubMed  CAS  Google Scholar 

  12. Runkel NS, Moody FG, Smith GS, et al.: The role of the gut in the development of sepsis in acute pancreatitis. J Surg Res 1991, 51:18–23.

    Article  PubMed  CAS  Google Scholar 

  13. Luiten EJT, Hop WCJ, Lange JF, et al.: Controlled clinical trial of selective decontamination from the treatment of severe acute pancreatitis. Am Surg 1995, 222:57–65.

    CAS  Google Scholar 

  14. Finch WT, Sawyers JL, Schenker S: A prospective study to determine the efficacy of antibiotics in acute pancreatitis. Ann Surg 1976, 183:667–671.

    Article  PubMed  CAS  Google Scholar 

  15. Craig RM, Dordal E, Myles L: The use of ampicillin in acute pancreatitis. Ann Intern Med 1975, 83:831–832.

    PubMed  CAS  Google Scholar 

  16. Howes R, Zuidema GD, Cameron JL: Evaluation of prophylactic antibiotics in acute pancreatitis. J Surg Res 1975, 18:197–200.

    Article  PubMed  CAS  Google Scholar 

  17. Beger HG, Bittner R, Block S, Buchler M: Bacterial contamination of pancreatic necrosis: a perspective clinical study. Gastroenterology 1986, 91:433–438.

    PubMed  CAS  Google Scholar 

  18. Buchler M, Malfertheiner P, Friess H, et al.: Human pancreatic tissue concentrations of bactericidal antibiotics. Gastroenterology 1992, 103:1902–1908.

    PubMed  CAS  Google Scholar 

  19. Pederzoli P, Bassi C, Vesontini S, et al.: A randomized multicenter clinical trial of antibiotic prophylaxis of septic complications in acute necrotizing pancreatitis with imipenem. Surg Gynecol Obstet 1993, 176:480–483. This study was the first that showed a benefit of treating patients with acute necrotizing pancreatitis with antibiotics. The study is well designed, but the problems of lack of blinding, sample size, and power become apparent to the interested reader.

    PubMed  CAS  Google Scholar 

  20. Saino V, Kemppainem E, Puolakkainen P, et al.: Early antibiotic treatment in acute necrotizing pancreatitis. Lancet 1995, 346:663–667.

    Article  Google Scholar 

  21. Schwarz M, Isenmann R, Meyer H, et al.: Antibiotic use in necrotizing pancreatitis: results of a controlled study. Dtsch Med Wochenschr 1997, 122:356–361.

    Article  PubMed  CAS  Google Scholar 

  22. Isenmann R, Runzi M, Kron M, et al.: Prophylactic antibiotic treatment in patients with predicted severe acute pancreatitis: A placebo-controlled double-blind trial. Gastroenterology 2004, 126:997–1004.

    Article  PubMed  CAS  Google Scholar 

  23. Delcenserie R, Yzet T, Ducroix JP: Prophylactic antibiotics in treatment of severe acute alcoholic pancreatitis. Pancreas 1996, 13:198–201.

    PubMed  CAS  Google Scholar 

  24. Nordback I, Sand J, Saaristo R, Paajanen H: Early treatment with antibiotics reduces the need for surgery in acute necrotizing pancreatitis: a single center study. J Gastrointest Surg 2001, 5:113–120.

    Article  PubMed  CAS  Google Scholar 

  25. Sharma VK, Howden CW: Prophylactic antibiotic administration reduces sepsis and mortality in acute pancreatitis: a meta-analysis. Pancreas 2001, 42:28–31. Although this analysis only includes three earlier studies, the paper provides a basis for performing meta-analysis on this subject.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Gastroenterology, Department of Medicine, Maimonides Medical Center, Mount Sinai School of Medicine, 2211 Emmons Avenue, 11235, Brooklyn, NY, USA

    Scott Tenner MD, MPH

Authors
  1. Issac Moyshenyat MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ephraim Mandell MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Scott Tenner MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Scott Tenner MD, MPH.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Moyshenyat, I., Mandell, E. & Tenner, S. Antibiotic prophylaxis of pancreatic infection in patients with necrotizing pancreatitis: Rationale, evidence, and recommendations. Curr Gastroenterol Rep 8, 121–126 (2006). https://doi.org/10.1007/s11894-006-0007-7

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11894-006-0007-7

Keywords

Search

Navigation