Antibiotics in the Treatment of Acute Pancreatitis - Findings froma a Randomized Multi-centre Prospective Study

Abstract

The objective of the present study was to evaluate the influence of antibiotic prophylaxis on the course of severe acute pancreatitis. Method: Patients were included in a multi-centre randomized study on the basis of clinical criteria of the Atlanta consensus or a CRP level above 150 mg/l.

To the treated group ciprofloxacin 200 mg twice a day and metronidazol 500 mg three times a day was administered for a period of two weeks. To the control group the same antibiotics were administered when infectious complications or an elevated temperature was recorded.

Results: The study included a total of 63 patients incl. 33 (13 women, 20 men) in the treated group and 30 (12 women, 18 men) in the control group. The most frequent etiology was biliary, followed by alcoholic.

The mean period of hospitalization in the treated group was 18.9 +- 8.1 days, in the control group 23.8 +- 19.3 days and the mean period at the intensive care unit 11.4 +- 5.4 days and 15.9 +- 12 days in the two groups resp. In the treated and control group in 15 and7 patients resp.

ERCP was performed and in 13 and 7 resp. endoscopic papillosphincterotomy. In the treated and control group there were 6 and 7 patients resp. treated surgically (3 necrectomies).

In the treated group 5 patients (15.2%) died while in the control group 3 (10.0%). The cause of death in the treated group was in one instance embolism into the pulmonary artery, myocardial infarction, shock and twice sepsis.

The cause of death in the control group was three times sepsis. Local complications were recorded in 13 patients in the treated group and 12 in the control group (pancreatic necrosis > 30% in 9 and 7 patients resp.) and infectious complications were found in 6 and 7 patients in both groups.

The differences in these mentioned parameters are not statistically significant.