Related Experiment Video
Updated: Jun 11, 2025
Author Spotlight: Advancements in Retroperitoneal Approach for Necrotizing Pancreatitis
Published on: March 15, 2024
Appropriate Use of Antibiotics in Acute Pancreatitis: A Scoping Review
Josep M Badia1, Sara Amador1, Carmen González-Sánchez2
1Department of Surgery, Hospital General Granollers, School of Medicine, Universitat Internacional de Catalunya, Av Francesc Ribas 1, 08402 Granollers, Spain.
Background:
While selective use of antibiotics for infected pancreatic necrosis (IPN) in acute pancreatitis (AP) is recommended, studies indicate a high rate of inadequate treatment.
Methods:
A search of PubMed, Scopus, and Cochrane databases was conducted, focusing on primary research and meta-analyses. Data were categorized based on core concepts, and a narrative synthesis was performed.
Results:
The search identified a total of 1016 publications. After evaluating 203 full texts and additional sources from the grey literature, 80 studies were included in the review. The answers obtained were: (1) Preventive treatment does not decrease the incidence of IPN or mortality. Given the risks of bacterial resistance and fungal infections, antibiotics should be reserved for highly suspected or confirmed IPN; (2) The diagnosis of IPN does not always require microbiological samples, as clinical suspicion or computed tomography signs can suffice. Early diagnosis and treatment may be improved by using biomarkers such as procalcitonin and novel microbiological methods; (3) When indicated, early initiation of antibiotics is a key determinant in reducing mortality associated with IPN; (4) Antibiotics with good penetration into pancreatic tissue covering Gram-negative and Gram-positive bacteria should be used. Routine antifungal therapy is not recommended; (5) The step-up approach, including antibiotics, is the standard for IPN management; (6) Antibiotic duration should be kept to a minimum and should be based on the quality of source control and patient condition.
Conclusions:
Early antibiotic therapy is essential for the treatment of IPN, but prophylactic antibiotics are not recommended in AP. High-quality randomized controlled trials are required to better understand the role of antibiotics and antifungals in AP management.
Insights
Antibiotics are crucial for treating infected pancreatic necrosis (IPN) in acute pancreatitis (AP) but should not be used preventatively. Early, targeted antibiotic therapy reduces mortality, while prophylactic use is not recommended.
Area of Science:
- Infectious Diseases
- Gastroenterology
- Critical Care Medicine
Background:
- Selective antibiotic use is recommended for infected pancreatic necrosis (IPN) in acute pancreatitis (AP).
- Existing studies reveal a high incidence of inadequate treatment for IPN.
- Antibiotic resistance and fungal infections are significant risks associated with prophylactic use.
Purpose of the Study:
- To review current evidence on antibiotic use in infected pancreatic necrosis (IPN).
- To clarify the role of prophylactic versus therapeutic antibiotics in acute pancreatitis (AP).
- To identify optimal diagnostic and management strategies for IPN.
Main Methods:
- Comprehensive literature search of PubMed, Scopus, and Cochrane databases.
- Inclusion of primary research and meta-analyses.
- Narrative synthesis of data categorized by core concepts.
Main Results:
- Preventive antibiotics do not decrease IPN incidence or mortality; reserve for confirmed/suspected IPN.
- Diagnosis can rely on clinical suspicion or CT signs, potentially aided by biomarkers like procalcitonin.
- Early antibiotic initiation is key to reducing IPN-related mortality.
- Use broad-spectrum antibiotics with good pancreatic penetration; avoid routine antifungals.
- The step-up approach is standard; minimize antibiotic duration based on source control and patient status.
Conclusions:
- Early antibiotic therapy is essential for IPN treatment, but prophylactic use in AP is not advised.
- High-quality randomized controlled trials are needed to further define antibiotic and antifungal roles in AP management.
More Related Videos
07:10Establishment of a Mouse Severe Acute Pancreatitis Model using Retrograde Injection of Sodium Taurocholate into the Biliopancreatic Duct
Published on: April 1, 2022
07:38Preparing a Mice Model of Severe Acute Pancreatitis via a Combination of Caerulein and Lipopolysaccharide Intraperitoneal Injection
Published on: May 10, 2024
Related Concept Videos
01:30Acute Pancreatitis II: Clinical Manifestations and Management
01:27Acute Pancreatitis I: Introduction
Acute pancreatitis is characterized by rapid inflammation of the pancreas, often caused by factors like gallstone blockage or excessive alcohol consumption. Chronic pancreatitis, on the other hand, is a slow, progressive inflammation that may result from long-term alcohol abuse, obstructions in the pancreatic duct, or genetic factors.
The causes of acute pancreatitis include:
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
01:29Chronic Pancreatitis II: Collaborative Care
Assessment:
01:24Chronic Pancreatitis I: Introduction
Pancreatitis is the inflammation of the pancreas, which occurs when the immune system becomes active and causes swelling, pain, and disruptions in organ function. Pancreatitis can manifest as either an acute or chronic condition.
Acute pancreatitis arises suddenly and lasts for a brief duration, while chronic pancreatitis is a long-term affliction...
01:17Urinary Tract Infection IV: Nursing Management