Bacterial Translocation in the Course of Acute Pancreatitis: Beneficial Role of Nonabsorbable Antibiotics and Lactitol Enemas

Marotta, Francesco; Geng, Tingting; Wu, Ching-Wen; Barbi, G

doi:10.1159/000201373

Cited by 67 publications

(42 citation statements)

References 23 publications

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“…A recently published meta-analysis reported significant reductions in respiratory tract infections and mortality in ICU patients given a combination of systemic and nonabsorbable oral antibiotics [24]. Evidence derived from animal studies has suggested a possible role for selective decontamination in reducing BT and septic morbidity in acute pancreatitis [25][26][27]. This was recently evaluated in a prospective randomised multi-centre trial of 102 patients with severe acute pancreatitis.…”

Section: Resultsmentioning

confidence: 99%

Gastric colonisation, intestinal permeability and septic morbidity in acute pancreatitis

et al. 2002

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Section: Resultsmentioning

confidence: 99%

Gastric colonisation, intestinal permeability and septic morbidity in acute pancreatitis

et al. 2002

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“…Investigations performed in rats with experimental acute pancreatitis [196] or ulcerative colitis [197] have shown that both rectal and oral administration of rifaximin decreased colonic bacterial translocation towards mesenteric lymph nodes. In the model of ANP [196] not only was the intra-abdominal spread of enteric bacteria ( fig.…”

Section: Selective Bowel Decontamination In Acute Pancreatitismentioning

confidence: 99%

“…In the model of ANP [196] not only was the intra-abdominal spread of enteric bacteria ( fig. 8) significantly reduced but also the pancreatic damage was lessened by rifaximin treatment.…”

Section: Selective Bowel Decontamination In Acute Pancreatitismentioning

confidence: 99%

Rifaximin, a Poorly Absorbed Antibiotic: Pharmacology and Clinical Potential

2005

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Rifaximin (4-deoxy-4′-methylpyrido[1′,2′-1,2]imidazo- [5,4-c]-rifamycin SV) is a synthetic antibiotic designed to modify the parent compound, rifamycin, in order to achieve low gastrointestinal (GI) absorption while retaining good antibacterial activity. Both experimental and clinical pharmacology clearly show that this compound is a nonsystemic antibiotic with a broad spectrum of antibacterial action covering Gram-positive and Gram-negative organisms, both aerobes and anaerobes. Being virtually nonabsorbed, its bioavailability within the GI tract is rather high with intraluminal and fecal drug concentrations that largely exceed the minimal inhibitory concentration values observed in vitro against a wide range of pathogenic organisms. The GI tract represents, therefore, the primary therapeutic target and GI infections the main indication. The appreciation of the pathogenic role of gut bacteria in several organic and functional GI diseases has increasingly broadened its clinical use, which is now extended to hepatic encephalopathy, small intestine bacterial overgrowth, inflammatory bowel disease and colonic diverticular disease. Potential indications include the irritable bowel syndrome and chronic constipation, Clostridium difficile infection and bowel preparation before colorectal surgery. Because of its antibacterial activity against the microorganism and the lack of strains with primary resistance, some preliminary studies have explored the rifaximin potential for Helicobacter pylori eradication. Oral administration of this drug, by getting rid of enteric bacteria, could also be employed to achieve selective bowel decontamination in acute pancreatitis, liver cirrhosis (thus preventing spontaneous bacterial peritonitis) and nonsteroidal anti-inflammatory drug (NSAID) use (lessening in that way NSAID enteropathy). This antibiotic has, therefore, little value outside the enteric area and this will minimize both antimicrobial resistance and systemic adverse events. Indeed, the drug proved to be safe in all patient populations, including young children. Although rifaximin has stood the test of time, it still attracts the attention of both basic scientists and clinicians. As a matter of fact, with the advancement of the knowledge on microbial-gut interactions in health and disease novel indications and new drug regimens are being explored. Besides widening the clinical use, the research on rifaximin is also focused on the synthesis of new derivatives and on the development of original formulations designed to expand the spectrum of its clinical use.

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“…Fermentation of lactulose by gramnegative bacteria produces short-chain fatty acids, which stimulate proliferation of jejunal, ileal and colonic mucosa. This positive effect of lactulose has been established in BT models in fed rats, such as biliary obstruction [20], cirrhosis [39], surgical trauma [21] and acute pancreatitis [40]. However, in the state of starvation (1) lactulose behaves as a carbohydrate energy source to the colonic flora and blocks the amino acid metabolism of the bacteria [41], and (2) there is deeper acidification than by the normal effect of lactulose, which also inhibits short-chain fatty acids arising from the breakdown of amino acids [42].…”

Section: Discussionmentioning

confidence: 99%

Effects of Hyperosmolar Agents – Lactulose, Lactitol, Sodium Phosphate and Polyethylene Glycol – on Cecal Coliform Bacteria during Traditional Bowel Cleansing: An Experimental Study in Rats

Demiroğullarι

Poyraz²,

Çırak

et al. 2004

Eur Surg Res

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Mechanical bowel cleansing is considered to be necessary prior to colorectal surgery, some radiological or endoscopic procedures, and for fecal disimpaction. Traditional bowel cleansing (TBC) with cathartics and enemas is a method of mechanical bowel cleansing for patients who have restrictive factors for whole-bowel irrigation (WBI), such as excessive fecal impaction, cardiac, hepatic or renal disorders. In this experimental study, TBC with hyperosmolar agents was evaluated in terms of their effects on colonic flora and bacterial translocation (BT). Sprague-Dawley rats were divided into 6 groups. The animals, except controls, were not fed for 72 h but received tap water ad libitum. During this period, lactulose, lactitol, sodium phosphate (NaP), polyethylene glycol 3350 (PEG3350) and physiological saline gavages were administered to the rats in groups 1–5, respectively, once a day. All animals except controls (group 6) received enemas with 15 ml of warm saline twice a day. The cecum, mesenteric lymph nodes (MLNs) and portal vein blood were sampled for microbiological and histopathological analysis. The highest level of coliform bacterial overgrowth and BT to MLNs were observed in the lactulose group, although the others, except the saline and control groups, also caused some degree of BT. Portal vein cultures were negative for all groups. Histopathological damage was not associated with cecal bacterial count and BT. As a result of this study, PEG3350 seems to be safer and more effective than lactulose, lactitol and NaP during TBC.

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Bacterial Translocation in the Course of Acute Pancreatitis: Beneficial Role of Nonabsorbable Antibiotics and Lactitol Enemas

Cited by 67 publications

References 23 publications

Gastric colonisation, intestinal permeability and septic morbidity in acute pancreatitis

Gastric colonisation, intestinal permeability and septic morbidity in acute pancreatitis

Rifaximin, a Poorly Absorbed Antibiotic: Pharmacology and Clinical Potential

Effects of Hyperosmolar Agents – Lactulose, Lactitol, Sodium Phosphate and Polyethylene Glycol – on Cecal Coliform Bacteria during Traditional Bowel Cleansing: An Experimental Study in Rats

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