2005 Abstracts: Antibiotic Prophylaxis for Pancreatic Necrosis: Does the Choice Of Agent Make a Difference?
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Antibiotic Prophylaxis for Pancreatic Necrosis: Does the Choice Of Agent Make a Difference?
Eduardo A. Villatoro, University of Nottingham, Derby, Derbyshire, United Kingdom (Great Britain)
*SSAT Member
INTRODUCTION: Controversy continues over the role of prophylactic antibiotics in pancreatic necrosis. Randomised controlled trials (RCT) have been inconclusive, and meta-analysis is hindered by variable entry criteria and antibiotic regimens. The aim of this study was to examine whether the choice of antibiotic influenced outcome from pancreatic necrosis. AIMS AND METHODS: Appropriate RCTs using contrast-enhanced CT as an entry criterion were sought, or those were CT details were extractable. Five relevant RCTs were identified: three evaluating a betalactam type regimen (175 patients) (Pederzoli 1993, Sainio 1995, Nordback 2001), and two a quinolone/imidazole combination (102 patients) (Schwarz 1997, Isenmann 2004). No study was adequately powered, and only one (a quinolone/imidazole regimen), was adequately double-blinded. Meta-analysis was performed using RevMan v 4.2 (Update, Oxon). RESULTS: Overall meta-analysis showed significantly reduced mortality from antibiotic therapy (p=0.01, odds ratio [OR] 0.37). Mortality was lower, but not significantly in betalactam (p=0.13, OR 0.45) and quinolone/imidazole (p=0.25, OR 0.45) subgroups. Infected necrosis was not significantly reduced overall (p=0.1, OR 0.62), but was in the betalactam subgroup (p=0.02, OR 0.41) and not in the quinolone/imidazole subgroups (p=0.61, OR 1.29). CONCLUSION: These results and those observed for other end points conflict with tissue penetration studies, and suggest that antibacterial spectrum is more important than pharmacokinetics. If further studies sustain these preliminary conclusions there would be profound implications for the management of severe acute pancreatitis where significant pancreatic necrosis is suspected or proven. REFERENCES: Pederzoli et al. SGO 1993;176(5):480-483.Sainio et al. Lancet 1995;346:663-667.
Nordback et al. J GI Surg 2001;5(2):113-118.
Schwarz et al. Dtsch med Wschr 1997;122:356-361.
Isenmann et al. Gastroenterology 2004;126:997-1004.
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