%0 Journal Article
%T Pro/con clinical debate: Antibiotics are important in the management of patients with pancreatitis with evidence of pancreatic necrosis
%A Graham Ramsay
%A Paul Breedveld
%A Lorne H Blackbourne
%A Stephen M Cohn
%J Critical Care
%D 2003
%I BioMed Central
%R 10.1186/cc2165
%X A 29-year-old male develops severe pancreatitis, presumably as a result of heavy alcohol intake. He is admitted to the hospital ward for management but becomes hypoxic over the first 24 hours, requiring intubation and mechanical ventilation. The patient is admitted to the intensive care unit and, in the course of investigation, he has an abdominal computed tomography scan that shows an inflamed pancreas with some necrotic areas. Although there are no obvious signs of infection, you wonder whether antibiotics are useful in the patient's management.Graham Ramsay and Paul BreedveldAntibiotic prophylaxis in necrotizing pancreatitis is attractive as 80% of all deaths from severe pancreatitis are due to infected necrosis, and the time scale for the occurrence of infection makes prophylaxis feasible.Early trials of antibiotic prophylaxis in pancreatitis were negative, probably due to inappropriate antibiotic choice and also due to failure to focus on necrotizing pancreatitis. With more appropriate antibiotics, however, there are now a number of published randomized clinical trials on prophylactic antibiotic use in the management of acute necrotizing pancreatitis [1-4]. These include only randomized clinical trials that make specific mention of acute pancreatitis, of incidence of pancreatic infection, of related sepsis and mortality, and that the antibiotics used had a minimal inhibitory concentration in the pancreas [5]. All four randomized clinical trials complied with at least one of the criteria in the guidelines for assessment of the quality of reports of randomized clinical trials of Jadad and colleagues [6].Pederzoli and colleagues included 74 patients, used imipenem and found a significant (P < 0.01) reduction of septic complications, such as infected pancreatic necrosis, peripancreatic abscesses or infected pseudocysts [1]. There was no significant reduction in multiorgan failure, in the need to operate or in mortality. Sainio and colleagues included 60 patients, u
%K antibiotic prophylaxis
%K critical care
%K multiorgan failure
%K pancreatic necrosis
%K pancreatitis
%U http://ccforum.com/content/7/5/351