Meta-analysis of prophylactic antibiotic use in acute necrotizing pancreatitis

Mazaki, Takero; Ishii, Yoshinori; Takayama, Tadatoshi

doi:10.1002/bjs.5389

Cited by 129 publications

(75 citation statements)

References 56 publications

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“…As mentioned above, 6 of the 18 studies included in the current review were associated with reduced mortality when prophylactic antibiotics were used and the remaining 12 meta-analyses did not recommend the use of prophylactic antibiotic as there was no significant reduction in mortality with them. [25][26][27][30][31][32][33][34][35][36][37][38] These meta-analyses used a combined total of 14 RCTs with total study population varied from 329 to 841 patients.…”

Section: Mortality In Pancreatitis: Are Antibiotics Protective?mentioning

confidence: 99%

Prophylactic antibiotics in acute pancreatitis: endless debate

Mourad

Evans

Kalidindi

et al. 2017

annals

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INTRODUCTION The development of pancreatic infection is associated with the development of a deteriorating disease with subsequent high morbidity and mortality. There is agreement that in mild pancreatitis there is no need to use antibiotics; in severe pancreatitis it would appear to be a logical choice to use antibiotics to prevent secondary pancreatic infection and decrease associated mortality. MATERIALS AND METHODS A non-systematic review of current evidence, meta-analyses and randomized controlled trials was conducted to assess the role of prophylactic antibiotics in acute pancreatitis and whether it might improve morbidity and mortality in pancreatitis. RESULTS Mixed evidence was found to support and refute the role of prophylactic antibiotics in acute pancreatitis. Most studies have failed to demonstrate much benefit from its routine use. Data from our unit suggested little benefit of their routine use, and showed that the mortality of those treated with antibiotics was significantly higher compared with those not treated with antibiotics (9% vs 0%, respectively, P = 0.043). In addition, the antibiotic group had significantly higher morbidity (36% vs 5%, respectively, P = 0.002). CONCLUSIONS Antibiotics should be used in patients who develop sepsis, infected necrosis-related systemic inflammatory response syndrome, multiple organ dysfunction syndrome or pancreatic and extra-pancreatic infection. Despite the many other factors that should be considered, prompt antibiotic therapy is recommended once inflammatory markers are raised, to prevent secondary pancreatic infection. Unfortunately, there remain many unanswered questions regarding the indications for antibiotic administration and the patients who benefit from antibiotic treatment in acute pancreatitis.

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Section: Mortality In Pancreatitis: Are Antibiotics Protective?mentioning

confidence: 99%

Prophylactic antibiotics in acute pancreatitis: endless debate

Mourad

Evans

Kalidindi

et al. 2017

annals

View full text Add to dashboard Cite

show abstract

“…Most of them concluded that administration of antibiotic prophylaxis is not recommended (Table 6) [57][58][59][60][61][62][63][64][65]. In the paper by Wittau et al, 14 trials were included with a total of 841 patients [66].…”

Section: Antibiotic Prophylaxismentioning

confidence: 99%

Antibiotics in severe acute pancreatitis

Serrablo

Tejedor²,

Martínez

2014

Open Medicine

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AbstractAcute pancreatitis (AP) is a local inflammatory response with systemic effects and an adverse evolution in 20% of cases. Its mortality rate is 5–10% in sterile and 15–40% in infected pancreatic necrosis. Infection is widely accepted as the main reason of death in AP. The evidence to enable a recommendation about antibiotic prophylaxis against infection of pancreatic necrosis is conflicting and difficult to interpret. Up to date, there is no evidence that supports the routine use of antibiotic prophylaxis in patients with severe AP. Treatment on demand seems to be the better option, avoiding excessive treatment and selection of bacterial. In infected acute pancreatitis, antibiotics of choice are imipenem, meronem or tigecycline in patients allergic to beta-lactams. Also fluconazole must be given in determinate clinical situations.

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“…The patients in the Besselink group received a higher number and more strains of probiotic organisms (six strains of probiotics vs. 1-4 strains of probiotics in other studies) and some of the patients were receiving pressors. Randomized controlled trials and meta-analysis have not demonstrated significant benefits of prophylactic antibiotics on patients with necrotizing acute pancreatitis [96][97][98]. Further largescale, high-quality, placebo-controlled, double-blind trials are needed.…”

Section: Probiotics and Acute Pancreatitismentioning

confidence: 99%

Probiotics: Mechanisms of Action and Clinical Applications

Gogineni¹,

Morrow²,

Malesker³

2013

J Prob Health

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Probiotics are living microorganisms which when taken in adequate amount provides benefit to the host. While this beneficial effect was originally thought to stem from improvements in the intestinal microbial balance, there is now substantial evidence that probiotics can also provide benefits by modulating immune functions. Extrapolation of immunomodulatory effects found in the laboratory and in animal studies with outcomes in human trials presents a difficult challenge. Not all probiotics are created equal and the benefits are strain and dose specific. With newer strain-specific clinical trials and meta-analysis of the clinical trials, the beneficial role of probiotics in certain diseases has been evolving. Some uncertainity still exists with probiotics in other diseases with regard to the therapeutic role, strain-specificity, dosage and duration. Identification of clinical characteristics of effective probiotic strains, their mechanisms of action and testing of probiotic-based treatment may provide the true beneficial effect of probiotics in various disorders.

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Meta-analysis of prophylactic antibiotic use in acute necrotizing pancreatitis

Abstract: Prophylactic antibiotics do not prevent infected necrosis or death in acute necrotizing pancreatitis.

Cited by 129 publications

References 56 publications

Prophylactic antibiotics in acute pancreatitis: endless debate

Prophylactic antibiotics in acute pancreatitis: endless debate

Antibiotics in severe acute pancreatitis

Probiotics: Mechanisms of Action and Clinical Applications

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