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Prophylaxis for septic complications in acute necrotizing pancreatitis
Author(s) -
Bassi Claudio,
Mangiante Gerardo,
Falconi Massimo,
Salvia Roberto,
Frigerio Isabella,
Pederzoli Paolo
Publication year - 2001
Publication title -
journal of hepato‐biliary‐pancreatic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 0944-1166
DOI - 10.1007/s005340170018
Subject(s) - medicine , acute pancreatitis , pancreatitis , antibiotics , enteral administration , parenteral nutrition , intensive care medicine , incidence (geometry) , antimicrobial , necrotizing pancreatitis , antibiotic prophylaxis , gastroenterology , surgery , microbiology and biotechnology , biology , physics , optics
Because the mortality of severe pancreatitis is higher when infected necrosis supervenes, prevention of infections has become a relevant endpoint for management. The “ideal” drug should be characterized by specific activity against the bacteria known to be responsible for infection and should be able to penetrate the gland in a sufficient concentration. To date there have been eight prospective trials with antibiotics, one on selective digestive decontamination, and others with enteral nutrition. A meta‐analysis regarding experiences with antimicrobial drugs reports a significant reduction in the incidence of infected necrosis and pancreatic abscesses during severe pancreatitis. In conclusion, among the several options aimed at reducing infections during necrotizing pancreatitis, the prophylactic use of antibacterial drugs is the only one to have been tested to date in several randomized studies. Strong consideration should be given to treating patients with severe pancreatitis with broadspectrum antibiotics, selective digestive decontamination, and enteral nutrition.