Prophylactic Antibiotics and Selective Digestive Decontamination in Severe Acute Pancreatitis

  • E. J. T. Luiten
  • H. A. Bruining

Abstract

The use of antibiotics in acute pancreatitis has been continuously debated for more than half a century. In 1950 Lewis and Wangensteen (1) reported reduced mortality in dogs with acute haemorrhagic pancreatitis treated with penicillin. Persky et al. (2) demonstrated that aureomycin, given orally, resulted in 100% survival after bile-induced necrotising pancreatitis in mongrel dogs. Cultures of pancreatic necrosis from non-surviving dogs treated without antibiotics, showed an increase of secondary pancreatic infection, especially with Clostridia. Subsequently, they found a moderate reduction of mortality with polyvalent clostridial toxoid, neomycin and polymyxin B (3). However, Byrne and Joison (4), discussing the primary role of bacteria in the pathogenesis of necrotising pancreatitis, found that neomycin, tetracyclin, penicillin and sulfonamide instilled in a closed duodenal loop, prevented the onset of necrotising pancreatitis. Thai et al. (5) mentioned increased survival when Escherichia coli-induced necrotising pancreatitis was treated with aureomycin. Similar results were also reported when antibiotics were used in germ-free dogs with necrotising pancreatitis, casting some doubt on the essential role of bacteria in the pathogenesis (6).

Keywords

Pseudomonas Bismuth Ampicillin Candida Amphotericin 

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References

  1. 1.
    Lewis FJ, Wangensteen OH (1950) Antibiotics in the treatment of experimental acute hemorrhagic pancreatitis in dogs. Proc Soc Exp Biol Med 74:453–455.PubMedGoogle Scholar
  2. 2.
    Persky L, Schweinberg FB, JacobS, Fine J (1951) Aureomycin in experimental acute pancreatitis of dogs. Surgery 30:652–656.PubMedGoogle Scholar
  3. 3.
    Schweinberg FB, Jacob S, PerskyL, Fine J (1953) Further studies on the role of bacteria in death from acute pancreatitis in dogs. Surgery 33:367.Google Scholar
  4. 4.
    Byrne JJ, Joison J (1964) Bacterial regurgitation in experimental pancreatitis. Am J Surg 107:317–320.PubMedCrossRefGoogle Scholar
  5. 5.
    Thai A, Tansathitaya P, Egner W (1956) An experimental study of bacterial pancreatitis. Surg Gynecol Obstet 103:459–468.Google Scholar
  6. 6.
    Tedesco VE III, Evans JT, NanceFC (1969) Antibiotic prevention of experimental hemorrhagic pancreatitis in germ-free and conventional dogs. Rev Surg 26:375.PubMedGoogle Scholar
  7. 7.
    Ponka JL, Landrum SE, Chaikof L (1961) Acute pancreatitis in the post-operative patient. Arch Surg 83:475–490.PubMedGoogle Scholar
  8. 8.
    Baker RJ (1972) Acute surgical diseases of the pancreas. Surg Clin North Am 52:239–256.PubMedGoogle Scholar
  9. 9.
    Rahman F, Geokas MC (1972) Pancreatitis: mortality, antibiotics. Ann Intern Med76:1044–1045.PubMedGoogle Scholar
  10. 10.
    Kodesch R, DuPont HL (1973) Infectious complications of acute pancreatitis. Surg Gynecol Obstet 136:763–768.PubMedGoogle Scholar
  11. 11.
    Howes R, Zuidema GD, Cameron JL (1975) Evaluation of prophylactic antibiotics inacute pancreatitis. J Surg Res 18:197–200.PubMedCrossRefGoogle Scholar
  12. 12.
    Craig RM, Dordal E, Myles L (1975) The use of ampicillin in acute pancreatitis. Ann Intern Med 83:831–832.PubMedGoogle Scholar
  13. 13.
    Finch WT, Sawyers JL, Schenker S (1976) A prospective study to determine the efficacy of antibiotics in acute pancreatitis. AnnSurg 183:667–671.PubMedCrossRefGoogle Scholar
  14. 14.
    Beger HG, Bittner R, Block S, Buchler M (1986) Bacterial contamination of pancreatic necrosis. A prospective clinical study. Gastroenterology 91:433–438.PubMedGoogle Scholar
  15. 15.
    Wilson C, Imrie CW (1991) Systemic effects of acute pancreatitis. In: Johnson CD, Imrie CW (eds) Pancreatic disease. Springer, London, pp 287–97.Google Scholar
  16. 16.
    Renner IG, Savage WT III, Pantoja JL, Renner VJ (1985) Death due to acute pancreatitis. A retrospective analysis of 405 autopsycases. Dig Dis Sei 30:1005–1018.CrossRefGoogle Scholar
  17. 17.
    Bradley EL III. Antibiotics in acute pancreatitis. Am J Surg 158:472–478.Google Scholar
  18. 18.
    Lumsden A, Bradley EL III (1990) Secondary pancreatic infections. Surg Gynecol Obstet 170:459–467.PubMedGoogle Scholar
  19. 19.
    Buggy BP, Nostrant TT (1983) Lethal pancreatitis. Am J Gastroenterol 78:810–814.PubMedGoogle Scholar
  20. 20.
    Johnson CD (1996) Antibiotic prophylaxis in severe acute pancreatitis. Br J Surg 83:883–884.PubMedCrossRefGoogle Scholar
  21. 21.
    Ranson JHC, Spencer FC (1977) Prevention, diagnosis and treatment of pancreaticabscesses. Surgery 82:99–106.PubMedGoogle Scholar
  22. 22.
    Isenmann R, Büchler MW (1994) Infection and acute pancreatitis. Br J Surg 81:1707–1708.PubMedCrossRefGoogle Scholar
  23. 23.
    Luiten EJT, Hop WCJ, Lange JF, Bruining HA (1995) Controlled clinical trial of selective decontamination for the treatment of severe acute pancreatitis. Ann Surg 222:57–65.PubMedCrossRefGoogle Scholar
  24. 24.
    Pederzoli P, Bassi C, VesentiniS, Campedelli A (1993) A randomized multicenter clinical trial of antibiotic prophylaxis of septic complications in acute necrotizing pancreatitis with imipenem. Surg Gynecol Obstet 176:480–483.PubMedGoogle Scholar
  25. 25.
    Büchler M, MalfertheinerP, Friess H et al. (1992) Human pancreatic tissue concentration of bactericidal antibiotics. Gastroenterology 103:1902–1908.PubMedGoogle Scholar
  26. 26.
    Gerzof SG, Banks PA, Robbins AHet al. (1987) Early diagnosis of pancreatic infection by computed tomography-guided aspiration. Gastroenterology 93:1315–1320.PubMedGoogle Scholar
  27. 27.
    Pederzoli P, Bassi C, VesentiniS et al. (1990) Retroperitoneal and peritoneal drainage and lavage in the treatment of severe necrotizing pancreatitis. Surg Gynecol Obstet 170:197–203.PubMedGoogle Scholar
  28. 28.
    Bradley EL III (1991) Operativemanagement of acute pancreatitis: ventral open packing. Hepatogastroenterology 38:134–138.PubMedGoogle Scholar
  29. 29.
    Widdison AL, Karanjia ND (1993)Pancreatic infection complicating acute pancreatitis. Br J Surg 80:148–154.PubMedCrossRefGoogle Scholar
  30. 30.
    Bittner R, Block S, Buchler M, Beger HG (1987) Pancreatic abscess and infected pancreatic necrosis. Different local septic complications in acute pancreatitis. Dig Dis Sci 32:1082–1087.PubMedCrossRefGoogle Scholar
  31. 31.
    Becker JM, Pemberton JH (1984) Prognostic factors in pancreatic abscesses. Surgery 96:455–460.PubMedGoogle Scholar
  32. 32.
    Donahue PE, Nyhus LM, Baker RJ (1980) Pancreatic abscess after alcoholic pancreatitis. Arch Surg 115:905–909.PubMedGoogle Scholar
  33. 33.
    Beger HG, Buchler M, Bittner R, Block S, Nevalainen T, Roscher R (1988) Necrosectomy and postoperative local lavage in necrotizing pancreatitis. Br J Surg 75:207–212.PubMedCrossRefGoogle Scholar
  34. 34.
    Beger HG, Rau B, Mayer J, Pralle U (1997) Natural course of acute pancreatitis. World J Surg 21:130–135.PubMedCrossRefGoogle Scholar
  35. 35.
    Bradley EL III (1993) A clinically based classification system for acute pancreatitis. Arch Surg 128:586–590.PubMedGoogle Scholar
  36. 36.
    Allardyce DB (1987) Incidence of necrotizing pancreatitis and factors related to mortality. Am J Surg 154:295–299.PubMedCrossRefGoogle Scholar
  37. 37.
    Bradley EL III, Allen K (1991) A prospective longitudinal study of observation versus surgical intervention in the management of necrotizing pancreatitis. Am J Surg 161:19–24.PubMedCrossRefGoogle Scholar
  38. 38.
    Warshaw AL (1974) Inflammatory masses following acute pancreatitis. Phlegmon, pseudocyst, and abscess. Surg Clin North Am 54:621–636.PubMedGoogle Scholar
  39. 39.
    Beger HG (1991) Surgery in acute pancreatitis. Hepatogastroenterology 38:92–96.PubMedGoogle Scholar
  40. 40.
    Bassi C, Falconi M, Girelli R et al. (1989) Microbiological findings in severe acute pancreatitis. Surg Res Commun 5:1–4.Google Scholar
  41. 41.
    Smadja C, Bismuth H (1986) Pancreatic debridement in acute necrotizing pancreatitis: an obsolete procedure? Br J Surg 73:408–410.PubMedCrossRefGoogle Scholar
  42. 42.
    Roscher R, Beger HG (1987) Bacterial infection of pancreatic necrosis. In: Beger HG, Büchler M (eds) Acute pancreatitis. Springer, New York, pp 314–320.Google Scholar
  43. 43.
    Luiten EJT, Hop WCJ, Lange JF, Bruining HA (1998) Differential prognosis of gram-negative versus gram-positive infected, and sterile pancreatic necrosis. Clin Inf Dis (in press).Google Scholar
  44. 44.
    Medich DS, Lee TK, Melhem MF, Rowe MI, Schraut WH, Lee KKW (1993) Pathogenesis of pancreatic sepsis. Am J Surg 165:46–52.PubMedCrossRefGoogle Scholar
  45. 45.
    Tarpila E, Nystrom PO, Franzen L et al. (1993) Bacterial translocation during acute pancreatitis in rats. Eur J Surg 159:109–113.PubMedGoogle Scholar
  46. 46.
    Foitzik T, Mithöfer K, Ferraro MJ et al. (1994) Time course of bacterial infection of the pancreas and its relation to disease severity in a rodent model of acute necrotizing pancreatitis. Ann Surg 220:193–198.PubMedCrossRefGoogle Scholar
  47. 47.
    Foitzik T, Fernández-del-Castillo C, Ferraro MJ et al. (1995) Pathogenesis and prevention of early pancreatic infection in experimental acute necrotizing pancreatitis. Ann Surg 222:179–185.PubMedCrossRefGoogle Scholar
  48. 48.
    Gianotti L, Munda R, Alexander JW (1992) Pancreatitis-induced microbial translocation: a study of the mechanisms. Res Surg 4:87–91.Google Scholar
  49. 49.
    Gianotti L, Munda R, Alexander JW et al. (1993) Bacterial translocation: a potential source for infection in acute pancreatitis. Pancreas 8:551–558.PubMedCrossRefGoogle Scholar
  50. 50.
    Runkel NS, Moody FG, Smith GS, Rodriguez LF, LaRocco MT, Miller TA (1991) The role of the gut in the development of sepsis in acute pancreatitis. J Surg Res 51:18–23.PubMedCrossRefGoogle Scholar
  51. 51.
    Wang X, Andersson R, Soltesz V et al. (1996) Gut origin sepsis, macrophage function and oxygen extraction associated with acute pancreatitis in the rat. World J Surg 20:299–308.PubMedCrossRefGoogle Scholar
  52. 52.
    Luiten EJT, Hop WCJ, Endtz HE, Bruining HA (1998) Prognostic importance of gram-negative intestinal colonization preceding pancreatic infection in severe acute pancreatitis. Intensive Care Med (Submitted).Google Scholar
  53. 53.
    Schwarz M, Büchler M, Meyer H et al. (1994) Effect of antibiotic treatment in patients with necrotizing pancreatitis and sterile necrosis. Pancreas 9:802.Google Scholar
  54. 54.
    Creutzfeldt W, Lankisch RG (1981) Intensive medical treatment of severe acute pancreatitis World J Surg 5:341–350.PubMedCrossRefGoogle Scholar
  55. 55.
    Beger HG (1991) Acute pancreatitis: a challenge to gastroenterologists and surgeons. Hepatogastroenterology 38:90–91.PubMedGoogle Scholar
  56. 56.
    Ihse I, Lempinen M, Worning H (1994) A clinically based classification system for acute pancreatitis. Scand J Gastroenterol 29:95–96.PubMedCrossRefGoogle Scholar
  57. 57.
    Banks PA (1994) Acute pancreatitis: medical and surgical management. Am J Gastroenterol 89: S78–S85.PubMedGoogle Scholar
  58. 58.
    Byrne JJ, Treadwell TL (1989) Treatment of pancreatitis. When do antibiotics have a role? Postgrad Med 85:333–339.PubMedGoogle Scholar
  59. 59.
    Trudel JL, Mutch DO, Brown PR, Richards GK, Brown RA (1982) Antibiotic therapy for pancreatic sepsis: differences in bioactive blood and tissue levels. Surg Forum 33:26–27.Google Scholar
  60. 60.
    Pederzoli P, Falconi M, Bassi C et al. (1987) Ciprofloxacin penetration in pancreatic juice. Chemotherapy 33:397–401.PubMedCrossRefGoogle Scholar
  61. 61.
    Brattstrom C, Malmbory AS, Tyden G (1989) Penetration of imipenem in pancreatic juice following single intravenous dose administration. Chemotherapy 35:83–87.PubMedCrossRefGoogle Scholar
  62. 62.
    Sainio V, Kemppainen E, Puolakkainen P et al. (1995) Early antibiotic treatment in acute necrotising pancreatitis. Lancet 346:663–667.PubMedCrossRefGoogle Scholar
  63. 63.
    Schwarz M, Isenmann R, Meyer H, Beger HG (1997) Antibiotika bei nekrotisierender Pankreatitis. Dtsch Med Wochenschr 122:356–361.PubMedCrossRefGoogle Scholar
  64. 64.
    Delcenserie R, Yzet T, Ducroix JP (1996) Prophylactic antibiotics in treatment of severe alcoholic pancreatitis. Pancreas 13:198–201.PubMedGoogle Scholar
  65. 65.
    Ranson JHC, Balthazar E, Caccavale R, Cooper M (1985) Computed tomography and the prediction of pancreatic abscess in acute pancreatitis. Ann Surg 201:656–665.PubMedCrossRefGoogle Scholar
  66. 66.
    Balthazar EJ, Ranson JH, Naidich DP, Megibow AJ, Caccavale R, Cooper MM (1985) Acute pancreatitis: prognostic value of CT. Radiology 156:767–772.PubMedGoogle Scholar
  67. 67.
    Lange JF, Teng HT, Menu M, vd Ham AC (1988) The role of computed tomography in the management of acute pancreatitis. Acta Chir Scand 154:461–465.PubMedGoogle Scholar
  68. 68.
    Ranson JHC (1984) Acute pancreatitis: pathogenesis, outcome and treatment. Clin Gastroenterol 13:843–863.PubMedGoogle Scholar
  69. 69.
    Warshaw AL, Jin GL (1985) Improved survival in 45 patients with pancreatic abscess. Ann Surg 202:408–417.PubMedCrossRefGoogle Scholar
  70. 70.
    Webster MW, Pasculle AW, Myerowitz RL, Rao KN, Lombardi B (1979) Postinduction bacteremia in experimental acute pancreatitis. Am J Surg 138:418–420.PubMedCrossRefGoogle Scholar
  71. 71.
    Wells CL, Rotstein OD, Pruett TL, Simmons RL (1986) Intestinal bacteria translocate into experimental intra-abdominal abscesses. Arch Surg 121:102–107.PubMedGoogle Scholar
  72. 72.
    Lange JF, van Gool J, Tytgat GN (1987) The protective effect of a reduction in intestinal flora on mortality of acute haemorrhagic pancreatitis in the rat. Hepatogastroenterology 34:28–30.PubMedGoogle Scholar
  73. 73.
    Stoutenbeek CP, van Saene HK, Miranda DR, Zandstra DF (1984) The effect of selective decontamination of the digestive tract on colonisation and infection rate in multiple trauma patients. Intensive Care Med 10:185–192.PubMedCrossRefGoogle Scholar
  74. 74.
    Blarney SL, Imrie CW, O’Neill J, Gilmour WH, Carter DC (1984) Prognostic factors in acute pancreatitis. Gut 25:1340–1346.CrossRefGoogle Scholar
  75. 75.
    Jackson RJ, Smith SD, Rowe MI (1990) Selective bowel decontamination results in gram-positive translocation. J Surg Res 48:444–447.PubMedCrossRefGoogle Scholar
  76. 76.
    Webb CH (1992) Antibiotic resistance associated with selective decontamination of the digestive tract. J Hosp Infect 22:1–5.CrossRefGoogle Scholar
  77. 77.
    Bradley EL III (1987) Management of infected necrosis by open drainage. Ann Surg 206:542–550.PubMedCrossRefGoogle Scholar
  78. 78.
    Rau B, Uhl W, Büchler MW, Beger HG (1997) Surgical treatment of infected necrosis. World J Surg 21:155–161.PubMedCrossRefGoogle Scholar
  79. 79.
    Hiatt JR, Fink AS, King W, Pitt HA (1985) Percutaneous aspiration of peripancreatic fluid collections: a safe and effective diagnostic technique. Dig Dis Sei 30:974–977.Google Scholar
  80. 80.
    D’egidio A, Schein M (1991) Surgical strategies in the treatment of pancreatic necrosis and infection. Br J Surg 78:133–137.PubMedCrossRefGoogle Scholar
  81. 81.
    Sulkowski U, Boin C, Brockmann J, Bünte H (1993) The influence of caecostomy and colonic irrigation on the pathophysiology and prognosis in acute experimental pancreatitis. Eur J Surg 159:287–291.PubMedGoogle Scholar
  82. 82.
    Gianotti L, Munda R, Gennari R, Pyles T, Wesley Alexander J (1995) Effect of different regimens of gut decontamination in bacterial translocation and mortality in experimental acute pancreatitis. Eur J Surg 161:85–92.PubMedGoogle Scholar
  83. 83.
    Meakins JL, Marshall JC (1986) The gastro-intestinal tract: The “motor” of multiple organ failure. Arch Surg 121:197–201.Google Scholar
  84. 84.
    Ranson JHC, Spencer FC (1978) The role of peritoneal lavage in severe acute pancreatitis. Ann Surg 187:565–575.PubMedCrossRefGoogle Scholar
  85. 85.
    Stone HH, Fabian TC (1980) Peritoneal dialysis in the treatment of acute alcoholic pancreatitis. Surg Gynecol Obstet 150:878–882.PubMedGoogle Scholar
  86. 86.
    Ihse I, Evander A, Holmberg JT, Gustafson I (1986) Influence of peritoneal lavage on objective prognostic signs in acute pancreatitis. Ann Surg 204:122–127.PubMedCrossRefGoogle Scholar
  87. 87.
    Rosato EF, Chu WH, Mullen JL, Rosato FE (1972) Peritoneal lavage treatment of experimental pancreatitis. J Surg Res 12:138–140.PubMedCrossRefGoogle Scholar
  88. 88.
    Mayer AD, McMahon MJ, Corfield AP et al. (1985) Controlled clinical trial of peritoneal lavage for the treatment of severe acute pancreatitis. N Engl J Med 312:399–404.PubMedCrossRefGoogle Scholar
  89. 89.
    Ranson JHC, Berman RS (1990) Long peritoneal lavage decreases pancreatic sepsis in acute pancreatitis. Ann Surg 211:708–718.PubMedCrossRefGoogle Scholar
  90. 90.
    Beger HG (1991) Operative management of necrotizing pancreatitis: necrosectomy and continuous closed postoperative lavage of the lesser sac. Hepatogastroenterology 38:129–133.PubMedGoogle Scholar

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© Springer-Verlag London Limited 1999

Authors and Affiliations

  • E. J. T. Luiten
  • H. A. Bruining

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