5200cea65dac901cb040f282efa6dc3f antibiotics-13-00894.pdf ec69c19fa45bc16b2f6056c84e5b5cedf524e05c antibiotics-13-00894.pdf 6fcfcab5561381b16326578d056f044af3c3ad34ed41e04f80de88e58545cbad antibiotics-13-00894.pdf Title: Appropriate Use of Antibiotics in Acute Pancreatitis: A Scoping Review Subject: 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. Keywords: acute pancreatitis; infected pancreatic necrosis; antibiotics; microbiology; prophylactic therapy; duration of treatment Author: Josep M. Badia, Sara Amador, Carmen González-Sánchez, Inés Rubio-Pérez, Alba Manuel-Vázquez, Montserrat Juvany, Estela Membrilla, José M. Balibrea and Xavier Guirao Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25 CreationDate: Wed Sep 18 10:16:16 2024 CEST ModDate: Wed Sep 18 10:29:37 2024 CEST Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 14 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 962531 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- GIFXFT+VnURWPalladioL-Bold Type 1 Custom yes yes yes 10 0 PTXHWW+URWPalladioL-Bold Type 1 Custom yes yes yes 16 0 BPPNZV+URWPalladioL-Roma Type 1 Custom yes yes yes 22 0 BQEICV+URWPalladioL-Ital Type 1 Custom yes yes yes 27 0 OPZDHV+VnURWPalladioL Type 1 Custom yes yes yes 32 0 YYFPCJ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 49 0 BCDEEE+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 74 0 BCDFEE+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 78 0 BCDGEE+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 82 0 BCDIEE+PalatinoLinotype-Bold CID TrueType Identity-H yes yes yes 86 0 BCDJEE+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 93 0 ArialMT TrueType WinAnsi no no no 101 0 Arial-BoldMT TrueType WinAnsi no no no 104 0 BCDMEE+Calibri TrueType WinAnsi yes yes no 107 0 BCDEEE+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 125 0 BCDFEE+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 129 0 BCDGEE+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 133 0 BCDHEE+PalatinoLinotype-Italic CID TrueType Identity-H yes yes yes 137 0 BCDIEE+PalatinoLinotype-Bold CID TrueType Identity-H yes yes yes 144 0 BCDJEE+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 151 0 DVCMRV+CMSY10 Type 1 Builtin yes yes yes 162 0 CRUZTT+VnURWPalladioL-Italic Type 1 Custom yes yes yes 195 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2025-07-03 02:09:04 CEST RepresentationInformation: antibiotics-13-00894.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2025-07-02 19:13:23 CEST Size: 962531 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 506 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Results Destination: section.2 Children: Item: Title: Definitions, Classification and Diagnosis Destination: subsection.2.1 Item: Title: Prediction of Severity Destination: subsection.2.2 Item: Title: Local Complications Destination: subsection.2.3 Item: Title: Infections and Microbiology of AP Destination: subsection.2.4 Item: Title: Management of IPN. Research Questions Destination: subsection.2.5 Children: Item: Title: Does Preventive Antibiotic Treatment Reduce Mortality in AP with Necrosis? Destination: subsubsection.2.5.1 Item: Title: How Is IPN Diagnosed? Destination: subsubsection.2.5.2 Item: Title: When Should Antibiotic Treatment Be Prescribed in AP? Destination: subsubsection.2.5.3 Item: Title: Which Antibiotics Are Indicated in the Treatment of IPN? Destination: subsubsection.2.5.4 Item: Title: What Is the Adequate Duration of Antibiotic Treatment? Destination: subsubsection.2.5.5 Item: Title: What Is the Role of the Step-Up Approach? Destination: subsubsection.2.5.6 Item: Title: Discussion Destination: section.3 Item: Title: Materials and Methods Destination: section.4 Children: Item: Title: Eligibility Criteria Destination: subsection.4.1 Item: Title: Search Strategy Destination: subsection.4.2 Item: Title: Selection of Sources of Evidence Destination: subsection.4.3 Item: Title: Synthesis of Results Destination: subsection.4.4 Item: Title: Research Questions Destination: subsection.4.5 Item: Title: Endpoints Destination: subsection.4.6 Item: Title: Conclusions, Data Gaps and Implications for Research and Practice Destination: section.5 Item: Title: References Destination: section.6 Info: Title: Appropriate Use of Antibiotics in Acute Pancreatitis: A Scoping Review Author: Josep M. Badia, Sara Amador, Carmen González-Sánchez, Inés Rubio-Pérez, Alba Manuel-Vázquez, Montserrat Juvany, Estela Membrilla, José M. Balibrea and Xavier Guirao Subject: 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. 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Annotation: Subtype: Link Rect: 260, 476, 298, 487 Annotation: Subtype: Link Rect: 412, 453, 449, 464 Annotation: Subtype: Link Rect: 349, 396, 386, 407 Annotation: Subtype: Link Rect: 228, 362, 266, 372 Annotation: Subtype: Link Rect: 173, 327, 211, 338 Annotation: Subtype: Link Rect: 217, 327, 253, 338 Annotation: Subtype: Link Rect: 178, 304, 216, 315 Annotation: Subtype: Link Rect: 222, 304, 258, 315 Annotation: Subtype: Link Rect: 59, 270, 95, 280 Checksum: 4e0cd19e Type: CRC32 Checksum: 5200cea65dac901cb040f282efa6dc3f Type: MD5 Checksum: ec69c19fa45bc16b2f6056c84e5b5cedf524e05c Type: SHA-1 Checksum: 6fcfcab5561381b16326578d056f044af3c3ad34ed41e04f80de88e58545cbad Type: SHA-256