Timing of antibiotic prophylaxis in acute pancreatitis

A controlled randomized study with meropenem

Gianpiero Manes, Ilaria Uomo, Antonella Menchise, Pier Giorgio Rabitti, Elisa Chiara Ferrara, Generoso Uomo

Research output: Contribution to journalArticle

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Abstract

OBJECTIVES: Antibiotic prophylaxis improves the outcome of acute pancreatitis. Since bacterial translocation from the gut occurs in the first h of disease, early therapy is likely to achieve the maximal effect. The study compares early antibiotic treatment with treatment started after the demonstration of pancreatic necrosis. METHODS: Two hundred fifteen patients with pancreatitis were randomized to either group A (N = 108), who started antibiotic therapy (meropenem 500 mg t.i.d.) at admission, or group B (N = 107), who received antibiotics after the demonstration of necrosis at computed tomography (CT). CT was performed in both groups after at least 48 hr of hospitalization. The clinical course of disease was compared in the two groups. RESULTS: Thirty patients in group A and 29 in B showed necrosis on CT. The two groups were similar in demographics and characteristics of disease. Antibiotic treatment was started after 4.56 ± 1.2 days from hospitalization in group B and after 1.07 ± 0.6 days in A. Pancreatic infection occurred in four patients in group A (13.3%) and in nine in B (31%) (p = 0.1). Extrapancreatic infection occurred in 16.6% of patients in group A and in 44.8% in B (p <0.05). Need for surgery and length of hospitalization were also higher in group B. Mortality rates were similar in the two groups, but, 3 of 4 patients with infected necrosis in group A and only 2 of 9 in group B died. CONCLUSIONS: Early antibiotic treatment is associated with a significant improvement in the prognosis of necrotizing acute pancreatitis (AP), because of a reduction in the occurrence of septic complications.

Original languageEnglish
Pages (from-to)1348-1353
Number of pages6
JournalAmerican Journal of Gastroenterology
Volume101
Issue number6
DOIs
Publication statusPublished - Jun 2006

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meropenem
Antibiotic Prophylaxis
Pancreatitis
Anti-Bacterial Agents
Necrosis
Tomography
Hospitalization
Hospitalization Insurance
Acute Necrotizing Pancreatitis
Bacterial Translocation
Therapeutics
Secondary Prevention
Infection
Demography
Mortality

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Timing of antibiotic prophylaxis in acute pancreatitis : A controlled randomized study with meropenem. / Manes, Gianpiero; Uomo, Ilaria; Menchise, Antonella; Rabitti, Pier Giorgio; Ferrara, Elisa Chiara; Uomo, Generoso.

In: American Journal of Gastroenterology, Vol. 101, No. 6, 06.2006, p. 1348-1353.

Research output: Contribution to journalArticle

Manes, Gianpiero ; Uomo, Ilaria ; Menchise, Antonella ; Rabitti, Pier Giorgio ; Ferrara, Elisa Chiara ; Uomo, Generoso. / Timing of antibiotic prophylaxis in acute pancreatitis : A controlled randomized study with meropenem. In: American Journal of Gastroenterology. 2006 ; Vol. 101, No. 6. pp. 1348-1353.
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abstract = "OBJECTIVES: Antibiotic prophylaxis improves the outcome of acute pancreatitis. Since bacterial translocation from the gut occurs in the first h of disease, early therapy is likely to achieve the maximal effect. The study compares early antibiotic treatment with treatment started after the demonstration of pancreatic necrosis. METHODS: Two hundred fifteen patients with pancreatitis were randomized to either group A (N = 108), who started antibiotic therapy (meropenem 500 mg t.i.d.) at admission, or group B (N = 107), who received antibiotics after the demonstration of necrosis at computed tomography (CT). CT was performed in both groups after at least 48 hr of hospitalization. The clinical course of disease was compared in the two groups. RESULTS: Thirty patients in group A and 29 in B showed necrosis on CT. The two groups were similar in demographics and characteristics of disease. Antibiotic treatment was started after 4.56 ± 1.2 days from hospitalization in group B and after 1.07 ± 0.6 days in A. Pancreatic infection occurred in four patients in group A (13.3{\%}) and in nine in B (31{\%}) (p = 0.1). Extrapancreatic infection occurred in 16.6{\%} of patients in group A and in 44.8{\%} in B (p <0.05). Need for surgery and length of hospitalization were also higher in group B. Mortality rates were similar in the two groups, but, 3 of 4 patients with infected necrosis in group A and only 2 of 9 in group B died. CONCLUSIONS: Early antibiotic treatment is associated with a significant improvement in the prognosis of necrotizing acute pancreatitis (AP), because of a reduction in the occurrence of septic complications.",
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N2 - OBJECTIVES: Antibiotic prophylaxis improves the outcome of acute pancreatitis. Since bacterial translocation from the gut occurs in the first h of disease, early therapy is likely to achieve the maximal effect. The study compares early antibiotic treatment with treatment started after the demonstration of pancreatic necrosis. METHODS: Two hundred fifteen patients with pancreatitis were randomized to either group A (N = 108), who started antibiotic therapy (meropenem 500 mg t.i.d.) at admission, or group B (N = 107), who received antibiotics after the demonstration of necrosis at computed tomography (CT). CT was performed in both groups after at least 48 hr of hospitalization. The clinical course of disease was compared in the two groups. RESULTS: Thirty patients in group A and 29 in B showed necrosis on CT. The two groups were similar in demographics and characteristics of disease. Antibiotic treatment was started after 4.56 ± 1.2 days from hospitalization in group B and after 1.07 ± 0.6 days in A. Pancreatic infection occurred in four patients in group A (13.3%) and in nine in B (31%) (p = 0.1). Extrapancreatic infection occurred in 16.6% of patients in group A and in 44.8% in B (p <0.05). Need for surgery and length of hospitalization were also higher in group B. Mortality rates were similar in the two groups, but, 3 of 4 patients with infected necrosis in group A and only 2 of 9 in group B died. CONCLUSIONS: Early antibiotic treatment is associated with a significant improvement in the prognosis of necrotizing acute pancreatitis (AP), because of a reduction in the occurrence of septic complications.

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