scholarly journals Meta-analysis of prophylactic parenteral antibiotic use in acute necrotizing pancreatitis

Medicina ◽  
2007 ◽  
Vol 43 (4) ◽  
pp. 291 ◽  
Author(s):  
Žilvinas Dambrauskas ◽  
Antanas Gulbinas ◽  
Juozas Pundzius ◽  
Giedrius Barauskas
Keyword(s):  
Clinical Trials ◽  
Acute Pancreatitis ◽  
Antibiotic Prophylaxis ◽  
Meta Analysis ◽  
Necrotizing Pancreatitis ◽  
Acute Necrotizing Pancreatitis ◽  
Evidence Based ◽  
Infected Necrosis ◽  
Acute Necrotizing ◽  
Overall Mortality

Background. Acute pancreatitis is a potentially serious condition. It carries an overall mortality rate of 10–15%. Infectious complications account for approximately 80% of deaths from acute pancreatitis, and the question arises whether or not prophylactic antibiotics are useful in the prevention of these complications. Therefore, we performed an evidence-based analysis to assess the effect of available prophylactic antimicrobial treatment on the development of infected necrosis and sepsis, need for surgery, and mortality. Methods. A comprehensive PubMed search was performed evaluating the value of prophylactic administration of parenteral antibiotics in patients with acute necrotizing pancreatitis. Only articles published in English language between January 1990 and May 2006 were included. The search strategy initially generated 692 articles related to antibiotics in the treatment of acute pancreatitis. This number was reduced to 97 publications related to clinical trials on the same topic. Finally, 10 randomized clinical trials concerning prophylactic parenteral antibiotics in patients with acute necrotizing pancreatitis were identified. We have performed a meta-analysis using the random-effects model to assess the impact of prophylactic antibiotics on development of infected pancreatic necrosis and sepsis, need for surgery, and overall mortality. Results. Patients with necrotizing acute pancreatitis should receive effective antibiotic prophylaxis (i.e., carbapenems intravenously) to decrease the risk of infected necrosis and sepsis and need of surgery. Conclusions. While providing new insights into key aspects of antibiotic prophylaxis, this evidence-based analysis highlights the need for further clinical trials regarding the indications for antibiotic prophylaxis.

Antibiotic Prophylaxis in Acute Necrotizing Pancreatitis Revisited

2009 ◽  
Vol 43 (9) ◽  
pp. 1486-1495 ◽  
Author(s):  
Marisel Segarra-Newnham ◽  
Augustus Hough
Keyword(s):  
Intensive Care ◽  
Antibiotic Prophylaxis ◽  
Randomized Trials ◽  
Necrotizing Pancreatitis ◽  
Acute Necrotizing Pancreatitis ◽  
On Demand ◽  
Previous Review ◽  
Significant Difference ◽  
Acute Necrotizing ◽  
Meta Analyses

Objective: To review studies of antibiotic prophylaxis in acute necrotizing pancreatitis published in the last decade and update recommendations. Data Sources: A search of PubMed (1998–July 2009) was conducted using the terms necrotizing pancreatitis, antibiotics, prophylaxis, and treatment. Clinical studies, meta-analyses, and review articles published in English were included. Additional references were obtained from article bibliographies. Randomized trials published before 1998 were included if indicated. Study Selection and Data Extraction: Relevant studies or meta-analyses on antibiotic prophylaxis since our previous review in 1998 were evaluated; older data were included if still relevant. Data Synthesis: Since our previous review, 4 more randomized trials, including 2 double-blind trials, have been conducted. The blinded studies found no significant difference in mortality with antibiotic prophylaxis compared with placebo, while the unblinded studies found a significant decrease in infections. Given these disparate results, available guidelines and meta-analyses provide different conclusions, usually based on exclusion or inclusion of a single trial. Based on all available data, antibiotic prophylaxis should not be used in patients with necrotizing pancreatitis. Instead, a more measured, on-demand use of antibiotics is preferred. Antibiotics should be added if signs and symptoms of infection are present (eg, fever, leukocytosis, positive results of cultures). Given improvements in intensive care and nutritional support, recent trials have found a lower incidence of infected necrotizing pancreatitis than before. Therefore, future trials are likely to need higher numbers of patients. Conclusions: Use of antibiotic prophylaxis for patients with necrotizing pancreatitis is not indicated, based on 2 blinded trials. Instead, on-demand use of antibiotics appears to be appropriate. Given progress in intensive care and the high crossover rate in studies, the need for antibiotic prophylaxis may continue to be debated for decades.

The burden of acute pancreatitis and early experience of step-up approach for acute necrotizing pancreatitis at Military Hospital

2019 ◽  
Vol 22 (2) ◽  
pp. 11-17
Author(s):  
Sushil Bahadur Rawal ◽  
Uttam Laudari ◽  
Basanta Khatiwada ◽  
Anup Thapa ◽  
Manoj Kumar Jha ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Necrotizing Pancreatitis ◽  
Early Experience ◽  
Acute Necrotizing Pancreatitis ◽  
Military Hospital ◽  
Army Hospital ◽  
Acute Necrotizing ◽  
Hospital Resources ◽  
Open Necrosectomy

Introduction: Twenty-five percent of acute pancreatitis develops severe acute pancreatitis (SAP). SAP patients have prolonged hospitalization and require a substantial amount of manpower and hospital resources. The aim of this study was to give an insight into the burden of acute pancreatitis at a tertiary level military hospital and to share the experience of managing pancreatic necrosis with the application of the step-up approach. Methods: A prospective descriptive study of consecutive patients was conducted at Shree Birendra Army Hospital from 2017 June to 2017 November. Patients with a diagnosis of acute pancreatitis admitted were stratified according to severity as per Revised Atlanta classification 2012. Patients with acute necrotizing pancreatitis were enrolled for the step-up approach. Patient’s demography, baseline investigations, radiology, prognostic scoring scales and type of intervention were analyzed. The burden of severe acute pancreatitis at our center and the early experience of the step-up approach at our centre within the study period were studied. Results: Out of 35 five patients with acute pancreatitis, 7 (20%) subsequently developed severe acute pancreatitis. Among them, five patients subsequently developed necrotizing pancreatitis who were managed according to the step-up approach. Out of them, three patients subsequently underwent operative intervention in the form of minimally invasive procedures like percutaneous drain placement, laparoscopic necrosectomy, video-assisted retroperitoneal debridement, and open necrosectomy. Conclusion: Acute pancreatitis is a common presentation at our centre. The step-up approach in the management of acute necrotizing pancreatitis is a safe and feasible approach.

Frequency of Left Plueral Effusion in Acute Necrotizing Pancreatitis

2021 ◽  
Vol 15 (10) ◽  
pp. 3349-3351
Author(s):  
Hunain . ◽  
Farah Saleem ◽  
Muhammad Waqas Arshad ◽  
Kauser Shaikh ◽  
Mamoona Shaikh ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Pleural Effusion ◽  
Serum Amylase ◽  
Necrotizing Pancreatitis ◽  
Case Series ◽  
Acute Necrotizing Pancreatitis ◽  
Amylase Level ◽  
X Ray ◽  
Left Pleural Effusion ◽  
Acute Necrotizing

Objective: The aim of this study is to calculate the prevalence of left plueral effusion in acute necrotizing pancreatitis. Study Design: Observational/ case series Place and Duration: Conducted at surgery department of Saidu Teaching Hospital, Swat and Ibne Sina Hospital and Research Institute, Multan for duration of six months from January 2021 to June 2021. Methods: A total of 95 patients, both males and females, ranging in age from 15 to 65 years, were presented. After receiving informed written consent, the baseline comprehensive demographics of the patients presented were recorded, including age, gender, and body mass index. Patients with acute pancreatitis and serum amylase levels greater than 300U/dL were eligible to participate. Patients were subjected to X-ray and CT scans in their entirety. Prevalence of necrotizing pancreatitis was calculated by CT scan and for left plueral effusion X-ray of chest was taken. SPSS 24.0 version was used to analyze complete data. Results: Majority of the patients 65 (68.4%) were females and 30 (31.6%) were males with mean age 39.14+5.67 years. 26 (27.4%) cases had BMI less than 20kg/m2 and the majority were >20kg/m2. Gallstone was the most common cause of acute pancreatitis found in 45 (47.4%) cases, followed by alcoholism 25 (26.3%) and medications 12 (12.6%). Among 95 cases, prevalence of necrotizing pancreatitis was 42 (44.2%) in which 40 cases had left plueral effusion. Mortality rate among necrotizing pancreatitis was 13 (33.3%). Conclusion: We found that the majority of individuals with necrotizing pancreatitis experienced pleural effusion on the left side. Thus, patients with acute pancreatitis who have a high serum amylase level must be treated earlier if they have a left pleural effusion because of severity. Keywords: Plueral Effusion, Acute Necrotizing Pancreatitis, Mortality

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