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 19 February 2018

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News

Antibiotic prophylaxis does not improve necrotizing pancreatitis

The latest Annals of Surgery reports no difference between early prophylactic antimicrobial use and placebo on infection or mortality in acute necrotizing pancreatitis.

News image

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In patients with severe, necrotizing pancreatitis, it is common to administer early, broad-spectrum antibiotics.

Often a carbapenem is given, in the hope of reducing the incidence of pancreatic and peripancreatic infections.

However, the benefits of doing so have not been proved.

Overall mortality rate was 20% in the meropenem group
Annals of Surgery

Dr Patchen Dellinger and colleagues undertook a multicenter, prospective, double-blind, placebo-controlled randomized study set in 32 centers within North America and Europe.

The research team assessed 100 patients with clinically severe, confirmed necrotizing pancreatitis.

Of these, 50 received meropenem and 50 received placebo.

The team administered meropenem 1 g intravenously every 8 hours or placebo within 5 days of the onset of symptoms for 7 to 21 days.

The team's primary endpoint was development of pancreatic or peripancreatic infection within 42 days following randomization.

Other endpoints included time between onset of pancreatitis, the development of pancreatic or peripancreatic infection, and all-cause mortality.

Requirement for surgical intervention, and development of nonpancreatic infections within 42 days following randomization were also evaluated.

The researchers found that pancreatic or peripancreatic infections developed in 18% of patients in the meropenem group compared with 12% in the placebo group.

The team noted that overall mortality rate was 20% in the meropenem group, and 18% in the placebo group.

Surgical intervention was required in 26% and 20% of the meropenem and placebo groups, respectively.

Dr Dellinger's team concluded, "This study demonstrated no statistically significant difference between the treatment groups for pancreatic or peripancreatic infection, or mortality."

"There was also no difference between the groups in the requirement for surgical intervention."

"Our findings do not support early prophylactic antimicrobial use in patients with severe acute necrotizing pancreatitis."

Ann Surg 2007: 245(5):674-83
10 May 2007

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