Antibiotika bei nekrotisierender Pankreatitis: Ergebnisse einer kontrollierten Studie

Schwarz, Michael; Isenmann, Rainer; Meyer, Hannelie; Beger, H. G.

doi:10.1055/s-2008-1047621

Cited by 170 publications

(16 citation statements)

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“…Sainio et al [11] showed a significant reduction of mortality when prophylactic antibiotics were used; however, the primary (one-side testing) and secondary (two-side testing) outcomes did not use the same Fisher exact test. No significant difference in mortality or IPN was found in Schwarz et al’s trial [12]. The need for surgery was significantly reduced in a trial evaluating the early administration of imipenem, but in this trial only 7 patients were proven microbiologically to have IPN [13].…”

Section: Discussionmentioning

confidence: 99%

“…Three types of antibiotics, carbapenems, fluoroquinolones, and cephalosporins, have been found to penetrate into the pancreas [8,9]. During the past decades, a number of studies have been done in order to determine whether it is necessary to administer antibiotics for ANP with conflicting results [10,11,12,13,14,15,16,17,18]. Meta-analyses have also been inconclusive [19,20,21,22,23,24].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Prophylactic Antibiotics Reduce Pancreatic Necrosis in Acute Necrotizing Pancreatitis: A Meta-Analysis of Randomized Trials

Yao

Huang²,

Li³

et al. 2010

Dig Surg

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Background and Aim: The use of prophylactic antibiotics to prevent infection and reduce mortality in patients with acute necrotizing pancreatitis (ANP) remains controversial. The aim of this study is to perform a systematic review of the data from randomized controlled trials to compare prophylactic antibiotic treatment of patients with ANP versus placebo. Methods: A computerized literature search was conducted using Medline, PubMed, EMBase and Cochrane Central Register of Controlled Trials (CENTRAL) for relevant articles published in English from January 1990 to March 2010. MeSH terms and keywords used to identify articles included ‘antibiotic’, ‘pancreatitis’, and ‘randomized’. Outcome measures were infected pancreatic necrosis (IPN), mortality, nonpancreatic infection (NPN) and need for surgical intervention. Results: Nine trials involving 564 patients were included. Analysis suggested that IPN was significantly reduced by treatment with antibiotics (RR 0.73, 95% CI 0.54–0.98, p = 0.04). Mortality (p = 0.1), NPN (p = 0.07), and need for surgical intervention (p = 0.17) were not significantly reduced by antibiotic treatment. Subsequent subgroup analysis confirmed that antibiotics were statistically superior to controls in reducing of infected necrosis (p = 0.003) and also mortality (p = 0.02) in single-blinded randomized controlled trials. Conclusion: Prophylactic antibiotic treatment reduced occurrence of IPN, but did not affect mortality, NPN, or surgical intervention in patients with ANP.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prophylactic Antibiotics Reduce Pancreatic Necrosis in Acute Necrotizing Pancreatitis: A Meta-Analysis of Randomized Trials

Yao

Huang²,

Li³

et al. 2010

Dig Surg

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“…In a previous study of our own group [21], using ofloxacin and metronidazole prophylaxis significantly improved the clinical course. Mortality could not significantly be reduced due to small patient numbers.…”

Section: Discussionmentioning

confidence: 89%

“…A shift from gram-negative bacteria to gram-positive has been reported [21,40]. Patients with pancreatic necrosis infected by Candida suffer a higher mortality compared to patients without Candida infection (64% vs 19%) [41].…”

Section: Discussionmentioning

confidence: 99%

Effect of early and late antibiotic treatment in experimental acute pancreatitis in rats

Schwarz

Poch

Isenmann

et al. 2007

Langenbecks Arch Surg

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In our animal model of necrotizing pancreatitis, early and late treatment with ciprofloxacin/metronidazole and imipenem reduce bacterial infection of the pancreas. Extrapancreatic infection, however, is reduced significantly only by early antibiotic treatment. The effectivity of early antibiotic treatment in the clinical setting should be subject to further investigation with improved study design and sufficient patient numbers.

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“…Two smaller studies had failed to confi rm these results ( table 5 ) [133,134] , but two metaanalyses of the then available data indicated that prophylactic antibiotics in patients with necrotizing pancreatitis probably has a positive effect on the course of the disease [135,136] . These results led to the recommendation of prophylactic antibiotic administration for patients with acute necrotizing pancreatitis in a number of recent guidelines and consensus recommendations ( table 3 ) [137][138][139][140][141][142][143][144] .…”

Section: Prevention Of Infected Pancreatic Necrosismentioning

confidence: 99%

Pharmacological Prevention and Treatment of Acute Pancreatitis: Where Are We Now?

Lankisch

Lerch²

2006

Dig Dis

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Acute pancreatitis is a disease of increasing prevalence, unchanged mortality over many decades, and limited treatment strategies. Progress has been made in developing therapies that reduce the rate of endoscopic retrograde cholangiopancreatography (ERCP)-associated pancreatitis and in preventing infected pancreatic necrosis with intravenous carbapenems. Attempts at reducing pancreatic enzyme output or inhibiting the activity of digestive enzyme proteases have not yielded encouraging results – nor have anti-inflammatory strategies for the treatment of acute pancreatitis been found to be effective so far. Future therapeutic options that are presently being developed or under investigation attempt to restore pancreatic secretory function, interfere with inflammatory pathways in a more effective manner, or inhibit digestive enzyme proteases more selectively.

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Antibiotika bei nekrotisierender Pankreatitis: Ergebnisse einer kontrollierten Studie

Abstract: Antibiotic prophylaxis neither prevented nor delayed bacterial infection of the necrotic pancreas. But it significantly improved the clinical course if started before the onset of infection of the pancreatic necroses.

Cited by 170 publications

References 0 publications

Prophylactic Antibiotics Reduce Pancreatic Necrosis in Acute Necrotizing Pancreatitis: A Meta-Analysis of Randomized Trials

Prophylactic Antibiotics Reduce Pancreatic Necrosis in Acute Necrotizing Pancreatitis: A Meta-Analysis of Randomized Trials

Effect of early and late antibiotic treatment in experimental acute pancreatitis in rats

Pharmacological Prevention and Treatment of Acute Pancreatitis: Where Are We Now?

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