In patients suspected of having severe acute pancreatitis, early antibiotic prophylaxis does not reduce the risk of developing infected pancreatic necrosis, other possible complications, or death.

According to current recommendations, antibiotic therapy should be prescribed as early as possible in patients with acute pancreatitis. However, clinical trials to support these recommendations were limited in the number of patients included and were not double blind in design.

Researchers from the University of Ulm under the direction of G. Beger (Hans G. Beger) carried out a double-blind study involving 114 patients. In all patients, the level of C-reactive protein in the blood plasma was greater than 150 mg / l or the site of tissue necrosis was determined by contrast computed tomography or both diagnostic signs were present. Empirically, ciprofloxacin and metronidazole were empirically prescribed to 58 patients, and 56 patients were randomized to placebo.

Patients have been prescribed a known antibacterial therapy regimen for the development of an infectious complication, multiple organ failure, or the development of a systemic inflammatory response syndrome. These signs were diagnosed in 16 (28%) patients in the antibiotic prophylaxis group and in 26 (46%) on placebo.

The main objective of the study was to investigate the incidence of pancreatic necrosis in the compared groups. In the first group, pancreatic necrosis was diagnosed in 5 (12%) patients and in the placebo group, also in 5 (9%) patients, the indicators were not statistically significant (p = 0.585). Mortality also did not differ significantly (5% and 7%), and there were no significant differences in the assessment of other parameters studied, such as length of hospital stay and frequency of systemic complications.

Prescribing antibiotic therapy as indicated is effective, as is antibiotic prophylaxis in this group of patients.

However, since the German study did not show differences in mortality and other parameters in the groups compared, Alphonso Brown of the University of North Carolina at Chapel Hill believes that the data on the efficacy of antibiotic prophylaxis to reduce the risk of death in severe acute pancreatitis - remains unconvincing.

Other controversial issues that need further research, according to American scientists, are the risk of developing fungal infections, the development of resistance during antibiotic prophylaxis, as well as the effect of prescribing enteral nutrition and the route. antibiotic administration.