TY - JOUR
T1 - Antibiotic therapy in acute pancreatitis
T2 - From global overuse to evidence based recommendations
AU - Hungarian Pancreatic Study Group
AU - Párniczky, Andrea
AU - Lantos, Tamás
AU - Tóth, Eszter Margit
AU - Szakács, Zsolt
AU - Gódi, Szilárd
AU - Hágendorn, Roland
AU - Illés, Dóra
AU - Koncz, Balázs
AU - Márta, Katalin
AU - Mikó, Alexandra
AU - Mosztbacher, Dóra
AU - Németh, Balázs Csaba
AU - Pécsi, Dániel
AU - Szabó, Anikó
AU - Szücs, Ákos
AU - Varjú, Péter
AU - Szentesi, Andrea
AU - Darvasi, Erika
AU - Erőss, Bálint
AU - Izbéki, Ferenc
AU - Gajdán, László
AU - Halász, Adrienn
AU - Vincze, Áron
AU - Szabó, Imre
AU - Pár, Gabriella
AU - Bajor, Judit
AU - Sarlós, Patrícia
AU - Czimmer, József
AU - Hamvas, József
AU - Takács, Tamás
AU - Szepes, Zoltán
AU - Czakó, László
AU - Varga, Márta
AU - Novák, János
AU - Bod, Barnabás
AU - Szepes, Attila
AU - Sümegi, János
AU - Papp, Mária
AU - Góg, Csaba
AU - Török, Imola
AU - Huang, Wei
AU - Xia, Qing
AU - Xue, Ping
AU - Li, Weiqin
AU - Chen, Weiwei
AU - Shirinskaya, Natalia V.
AU - Poluektov, Vladimir L.
AU - Shirinskaya, Anna V.
AU - Hegyi, Péter Jenő
AU - Capurso, Gabriele
PY - 2019/6
Y1 - 2019/6
N2 - Background: Unwarranted administration of antibiotics in acute pancreatitis presents a global challenge. The clinical reasoning behind the misuse is poorly understood. Our aim was to investigate current clinical practices and develop recommendations that guide clinicians in prescribing antibiotic treatment in acute pancreatitis. Methods: Four methods were used. 1) Systematic data collection was performed to summarize current evidence; 2) a retrospective questionnaire was developed to understand the current global clinical practice; 3) five years of prospectively collected data were analysed to identify the clinical parameters used by medical teams in the decision making process, and finally; 4) the UpToDate Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was applied to provide evidence based recommendations for healthcare professionals. Results: The systematic literature search revealed no consensus on the start of AB therapy in patients with no bacterial culture test. Retrospective data collection on 9728 patients from 22 countries indicated a wide range (31–82%) of antibiotic use frequency in AP. Analysis of 56 variables from 962 patients showed that clinicians initiate antibiotic therapy based on increased WBC and/or elevated CRP, lipase and amylase levels. The above mentioned four laboratory parameters showed no association with infection in the early phase of acute pancreatitis. Instead, procalcitonin levels proved to be a better biomarker of early infection. Patients with suspected infection because of fever had no benefit from antibiotic therapy. Conclusions: The authors formulated four consensus statements to urge reduction of unjustified antibiotic treatment in acute pancreatitis and to use procalcitonin rather than WBC or CRP as biomarkers to guide decision-making.
AB - Background: Unwarranted administration of antibiotics in acute pancreatitis presents a global challenge. The clinical reasoning behind the misuse is poorly understood. Our aim was to investigate current clinical practices and develop recommendations that guide clinicians in prescribing antibiotic treatment in acute pancreatitis. Methods: Four methods were used. 1) Systematic data collection was performed to summarize current evidence; 2) a retrospective questionnaire was developed to understand the current global clinical practice; 3) five years of prospectively collected data were analysed to identify the clinical parameters used by medical teams in the decision making process, and finally; 4) the UpToDate Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was applied to provide evidence based recommendations for healthcare professionals. Results: The systematic literature search revealed no consensus on the start of AB therapy in patients with no bacterial culture test. Retrospective data collection on 9728 patients from 22 countries indicated a wide range (31–82%) of antibiotic use frequency in AP. Analysis of 56 variables from 962 patients showed that clinicians initiate antibiotic therapy based on increased WBC and/or elevated CRP, lipase and amylase levels. The above mentioned four laboratory parameters showed no association with infection in the early phase of acute pancreatitis. Instead, procalcitonin levels proved to be a better biomarker of early infection. Patients with suspected infection because of fever had no benefit from antibiotic therapy. Conclusions: The authors formulated four consensus statements to urge reduction of unjustified antibiotic treatment in acute pancreatitis and to use procalcitonin rather than WBC or CRP as biomarkers to guide decision-making.
KW - Acute pancreatitis
KW - Antibiotic
KW - Guideline
KW - Infection
KW - Recommendation
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UR - http://www.scopus.com/inward/citedby.url?scp=85065106536&partnerID=8YFLogxK
U2 - 10.1016/j.pan.2019.04.003
DO - 10.1016/j.pan.2019.04.003
M3 - Article
C2 - 31068256
AN - SCOPUS:85065106536
VL - 19
SP - 488
EP - 499
JO - Pancreatology
JF - Pancreatology
SN - 1424-3903
IS - 4
ER -