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

Abstract

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.

Antibiotic prophylaxis in severe acute pancreatitis

“…was found with 10 8 CFU/g in the duodenum, jejunum and ileum, and 10 9 CFU/g in the cecum. Animals treated with ciprofloxacin prophylaxis or therapy had no measurable growth in the duodenum and jejunum [11]. Intestinal flora was reduced significantly compared with control groups with pancreatitis and even compared with sham-operated animals.…”

“…Regarding the time course of pancreatic infection, Schwarz et al [8] have been able to demonstrate that 8 h after the induction of necrotizing pancreatitis, the infection rate was 8%, increasing to 77% within the next 8 h. From these data, one can conclude that pancreatic infection in rats occurs early in the course of necrotizing pancreatitis, within 8-16 h after induction. Using a taurocholate pancreatitis model for the induction of necrotizing pancreatitis, 58% of the animals showed infected necrosis; however, 50% had bacteria in the peritoneal fluid, 27% in the spleen, 36% in the liver, 70% in the mesenteric lymph nodes, and every second animal showed blood culture positive for bacteria resembling germs of the intestinal flora [11]. The prophylactic treatment with a combination of ciprofloxacin and metronidazole resulted in a significant reduction of pancreatic infection, but no significant reduction was observed when imipenem was used.…”

Establishment of a Secondary Infection Model of Severe Acute Pancreatitis in Swine

“…It was therefore reasonable to use E. coli to induce secondary infections in the present study. Various mixed infection cases, composed of different bacterial or fungal strains, have been reported in recent years as a consequence of antibiotic abuse, 26,27 suggesting that other pathogens can be used to cause secondary infections associated with SAP. Compared with the traditional 1-step SAP induction models (simultaneous retrograde injection of sodium taurocholate and E. coli into the pancreatic duct 11 ), the 2-step SAP model described in this report requires the use of additional experimental procedures but avoids E. coli inactivation by sodium taurocholate, 28 better paralleling the clinical course of disease in humans and more accurately reflecting changes in blood biochemistry and in tissues before and after infection.…”

The use of antibiotics for acute pancreatitis: Is there a role?

“…However, extrapancreatic infection was only reduced by early antibiotic application. Quinolones reduced bacterial counts in the small and large bowel, whereas only early imipenem treatment was able to prevent bacterial colonization of the small intestine [40].…”