Prophylactic Antibiotics and Selective Digestive Decontamination in Severe Acute Pancreatitis

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


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).


Acute Pancreatitis Severe Acute Pancreatitis Pancreatic Necrosis Acute Necrotising Pancreatitis Infected Pancreatic Necrosis 
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  • E. J. T. Luiten
  • H. A. Bruining

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