Antibiotic prophylaxis with acute pancreatitis

Abstract

Necrotizing pancreatitis continues to be associated with considerable morbidity and mortality. The serious risk factor is pancreatic infection, which appears most often after the third week through the process of bacterial translocation. The question of antibiotic prophylaxis thus appears to be a relevant issue. The group of studies dealing with the pharmacokinetics ascertained variable penetration into the pancreas and variable potential effect against presumed bacterial infection. In clinical studies, ciprofloxacin with metronidazole, imipenem, meropenem and cephalosporins were most often administered. Most valuable are the randomized studies with ciprofloxacin, imipenem and meropenem, which did not prove the effect of antibiotic prophylaxis. Similarly, we did not confirm the contribution of antibiotic prophylaxis in our two studies. The prospective studies were evaluated in several meta-analyses. The early meta-analyses recommended the antibiotic prophylaxis, the other, involving the most valuable randomized trials, did not. The studies are in agreement that despite the antibiotic prophylaxis the infection of pancreatic necrosis and also extra-pancreatic infections appear often. No one study proved an influence on the course of the disease in association with its severity. In mild pancreatitis, antibiotic prophylaxis is not justified. In case of severe pancreatitis associated with SIRS and organ failure, antibiotic prevention is a matter of individual choice. The clinical condition, markers of inflammation, bacteriological examination and the results of imaging methods are continuously evaluated. According to the author's personal experience, the exceptions are pancreatitis after ERCP and traumatic pancreatitis, where the infection is directly spread. Here, the antibiotics should be given routinely and immediately. The most frequently recommended antibiotic regimes are ciprofloxacin in combination with metronidazole or carbapenems.