Early antibiotic treatment in acute necrotising pancreatitis

Sainio, V; Kemppainen, Esko; Puolakkainen, Pauli; Haapiainen, Reijo; Schröder, T; Kivilaakso, Eero; Valtonen, Ville; Taavitsainen, M.; Kivisaarl, L

doi:10.1016/s0140-6736(95)92280-6

Cited by 439 publications

(224 citation statements)

References 19 publications

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“…A more realistic goal in AP patients is the prediction of severity [15,16]; in fact, early assessment of severity in AP can permit the selection of those patients who will benefit from a more intensive and early treatment with antibiotics [17] or antiprotease drugs [18], although this last point is still being debated [19,20]. Unfortunately, in this respect, plasma Cal assay did not offer any advantage.…”

Section: Discussionmentioning

confidence: 99%

Plasma Calprotectin Levels in Patients Suffering from Acute Pancreatitis

Carroccio

Rocco²,

Rabitti³

et al. 2006

Dig Dis Sci

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Calprotectin (Cal) concentration is elevated in acute inflammatory reactions and its increase in the plasma suggests a diagnostic potential for Cal assay. This study aimed (a) to evaluate the Cal plasma levels in patients suffering from acute pancreatitis (AP) and (b) to assess whether early assay of Cal plasma levels can be helpful in assessment of the severity of AP. Forty-six consecutive patients, median age 45 years, suffering from a first attack of AP were recruited at two medical centers. Data collected on admission included age, sex, delay between pain onset and admission, and Glasgow score. A severe outcome was defined according to the Atlanta criteria. AP was defined as edematous or necrotic according to the CT findings. Plasma Cal and serum C reactive protein (CRP) were assayed in all patients within the first 24 hr after hospitalization. Sixty subjects suffering from blood hypertension were recruited as controls. Plasma Cal was measured by a commercial ELISA system. In all AP patients and in none of the controls, plasma Cal concentration was higher than the normal limit. Cal values in AP pa- tients were significantly higher than in controls (P < 0.0001). There was not a statistically significant difference in Cal values between patients with severe and patients with mild AP. Plasma Cal values did not differ in necrotizing and edematous AP. During the follow-up plasma Cal was reassayed in six of the patients with abdominal fluid collection and the values were higher in the two patients with infected necrosis. We conclude that plasma Cal is elevated in patients with AP but it is not a useful marker for early prediction of pancreatitis severity. Further studies could evaluate its usefulness in pancreatic infected necrosis.

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Section: Discussionmentioning

confidence: 99%

Plasma Calprotectin Levels in Patients Suffering from Acute Pancreatitis

Carroccio

Rocco²,

Rabitti³

et al. 2006

Dig Dis Sci

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“…Five of these studies used IV antibiotics (112-114, 120, 122) and one used selective decontamination of the digestive tract (121). Among these studies, three (113,120,121) demonstrated a decrease in infected necrosis with the use of prophylactic antibiotics, and two did not (112,122). None showed a convincing decrease in mortality.…”

Section: Level Of Evidence: IIImentioning

confidence: 99%

“…None showed a convincing decrease in mortality. There have been two meta-analyses: one (184) evaluated three of these studies (112,114,120) and a fourth that was published in German; the other (185) evaluated two studies (112,120) and the same article published in German. The conclusion reached in one (185) was that antibiotic prophylaxis significantly reduced mortality, and in the other that antibiotics reduced pancreatic infection (184).…”

Section: Level Of Evidence: IIImentioning

confidence: 99%

“…The types of surgery that have generally been recommended have included necrosectomy with closed continuous irrigation via indwelling catheters (47,55,89,104,110,112,119,156,164,169), necrosectomy and open packing (89,104,116,119,156,164,169), or necrosectomy with closed drainage without irrigation (89, 106). There have not been randomized prospective trials comparing these procedures.…”

Section: Level Of Evidence: IIImentioning

confidence: 99%

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Practice Guidelines in Acute Pancreatitis

Banks

Freeman

2006

Am J Gastroenterology

1,662

980

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“…Only a single adequately powered study [20] of cefuroxime has shown significant decrease in mortality with another small inadequately powered study [21] of ofloxacin/metronidazole combination showing no mortality in patients receiving antibiotic prophylaxis. Despite this inconsistent benefit of prophylactic antibiotics, most centers throughout the world are using such regimens.…”

Section: Role Of Intravenous Antibioticsmentioning

confidence: 99%