Antibiotic prophylaxis in severe acute pancreatitis: Randomized multicenter prospective study with meropenem

Hejtmankova, Sona; Čech, Petr; Hoskovec, David; Kostka, R; Leffler, J; Kasalický, M; Svoboda, Petr; Bártová, Jolana; Špičák, Julius

doi:10.1016/s0016-5085(03)80417-1

Cited by 4 publications

(1 citation statement)

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“…Two randomized controlled trials with 198 participants, rated as high-quality studies, were analyzed for all four outcomes ( 7 - 9 , 11 - 17 ). When only high-quality studies with low bias risks were included in the analysis, our results showed no significant difference for mortality (RR=1.00, 95% CI=0.54-1.84, I²=0%), peripancreatic infection (RR=1.54, 95% CI=0.65-3.47, I²=0%) and non-pancreatic infection (RR=0.72, 95% CI=0.48-1.07, I²=0%) ( Appendix , Figure 1d, 3d, 4d).…”

Section: Resultsmentioning

confidence: 99%

The Effect of Prophylactic Carbapenem Use on Outcomes in Acute Pancreatitis: A Systematic Review and Meta-Analysis

Buyukkoruk,

Senturk,

Ozger

2023

Infect Dis Clin Microbiol

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Objective: This study aimed to determine the effect of prophylactic use of carbapenems for acute pancreatitis on clinical outcomes. Materials and Methods: It was conducted according to the preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines by using the keywords “Pancrea* AND carbapenem OR imipenem OR ertapenem OR meropenem OR doripenem.” Primer outcomes were mortality, surgical intervention, and pancreatic and non-pancreatic infection. Subgroup analyses were also performed to reduce the risk of bias. Results: Ten studies with 4038 patients were included in the meta-analyses. While eight of ten were randomized controlled trials, two were observational studies. The prophylactic use of carbapenems had no statistically significant effect on mortality (OR=0.82, 95% CI=0.65-1.04, I²=0%) and surgical intervention. (OR=0.81, 95% CI=0.57-1.17, I²=0%). However, the real impact of prophylaxis on reducing the incidence of mortality and surgical intervention was uncertain due to the insufficient sample size. The prophylactic use of carbapenems was significantly associated with a lower risk of peripancreatic (OR=0.37, 95% CI=0.25-0.55, I²=61%) and non-pancreatic infection risk (OR=0.60, 95% CI=0.46-0.78, I²=65%). The definitions of infection in the articles were not clear, and the diagnostic approach to infection was based on subjective criteria. In addition, there was inadequate collateral damage and safety assessments. In high-quality studies with a low risk of bias, prophylactic carbapenems had no effect on peripancreatic infection (RR=1.54, 95% CI=0.65-3.47, I²=0%) and non-pancreatic infection (RR=0.72, 95% CI=0.48-1.07, I²=0%). Conclusion: Although there is a reduction in the infection risk, routine carbapenem use in acute pancreatitis cases should not be recommended based on current evidence. Cooperation with Infectious Disease specialists and developing diagnostic algorithms are required instead of routine prophylaxis to prevent infection, especially non-pancreatic infection. Keywords: acute pancreatitis, necrotizing pancreatitis, carbapenem, prophylaxis, systematic review, meta-analysis

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Section: Resultsmentioning

confidence: 99%

The Effect of Prophylactic Carbapenem Use on Outcomes in Acute Pancreatitis: A Systematic Review and Meta-Analysis

Buyukkoruk,

Senturk,

Ozger

2023

Infect Dis Clin Microbiol

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Pharmacological interventions for acute pancreatitis

Moggia

Koti

Belgaumkar

et al. 2017

Cochrane Database of Systematic Reviews

105

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Very low-quality evidence suggests that none of the pharmacological treatments studied decrease short-term mortality in people with acute pancreatitis. However, the confidence intervals were wide and consistent with an increase or decrease in short-term mortality due to the interventions. We did not find consistent clinical benefits with any intervention. Because of the limitations in the prognostic scoring systems and because damage to organs may occur in acute pancreatitis before they are clinically manifest, future trials should consider including pancreatitis of all severity but power the study to measure the differences in the subgroup of people with severe acute pancreatitis. It may be difficult to power the studies based on mortality. Future trials in participants with acute pancreatitis should consider other outcomes such as complications or health-related quality of life as primary outcomes. Such trials should include health-related quality of life, costs, and return to work as outcomes and should follow patients for at least three months (preferably for at least one year).

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Role of Prophylactic Antibiotic Administration in Severe Acute Pancreatitis: A Meta-Analysis

Xiong

Wang

2006

Med Princ Pract

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Objective: To carry out a meta-analysis of published studies in order to evaluate the clinical efficacy of prophylactic antibiotics in severe acute pancreatitis (SAP). Material and Methods: MEDLINE, China Biological Medicine, Embase and Cochrane Data Base for Systematic Reviews were searched for randomized controlled trials on the efficacy of prophylactic antibiotics in patients with SAP from 1966 to 2004. Six studies met our inclusion criteria. Two authors (G.S.X. and Z.H.W.) independently extracted the following data from these studies: trial design, characteristics of participants and outcomes. Data were analyzed by Revman 4.2 software. Results: In patients with SAP, prophylactic antibiotics, including broad-spectrum antibiotics that usually achieve therapeutic pancreatic tissue levels, did not reduce pancreatic infection (relative risk, RR, 0.77, 95% confidence interval 0.48–1.24, p = 0.28), surgical intervention (RR 0.84, 95% confidence interval 0.40–1.74, p = 0.64) and mortality rate (RR 0.54, 95% confidence interval 0.28–1.04, p = 0.07). Conclusions: Prophylactic antibiotic administration is not an appropriate treatment strategy in patients with SAP, it should be limited in patients with pancreatic necrosis, as demonstrated by computerized tomography.

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Antibiotic prophylaxis in severe acute pancreatitis: Randomized multicenter prospective study with meropenem

Cited by 4 publications

References 0 publications

The Effect of Prophylactic Carbapenem Use on Outcomes in Acute Pancreatitis: A Systematic Review and Meta-Analysis

The Effect of Prophylactic Carbapenem Use on Outcomes in Acute Pancreatitis: A Systematic Review and Meta-Analysis

Pharmacological interventions for acute pancreatitis

Role of Prophylactic Antibiotic Administration in Severe Acute Pancreatitis: A Meta-Analysis

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