Appropriate Use of Antibiotics in Acute Pancreatitis : A Scoping Review
Badia, Josep M (Hospital General de Granollers)
Amador, Sara (Hospital General de Granollers)
González-Sánchez, Carmen (Hospital Universitario de Salamanca)
Rubio-Pérez, Inés (Hospital Universitario La Paz (Madrid))
Manuel-Vázquez, Alba (Hospital Universitario de Getafe (Madrid))
Juvany, Montserrat (Hospital del Mar (Barcelona, Catalunya))
Membrilla, Estela (Hospital del Mar (Barcelona, Catalunya))
Balibrea Del Castillo, José María (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Guirao Garriga, Xavier (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))

Date:	2024
Abstract:	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.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article de revisió ; recerca ; Versió publicada
Subject:	Acute pancreatitis ; Infected pancreatic necrosis ; Antibiotics ; Microbiology ; Prophylactic therapy ; Duration of treatment
Published in:	Antibiotics, Vol. 13 Núm. 9 (September 2024) , ISSN 2079-6382

DOI: 10.3390/antibiotics13090894
PMID: 39335067

14 p, 940.0 KB

The record appears in these collections:
Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP)
Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Parc Taulí Research and Innovation Institute (I3PT
Articles > Research articles
Articles > Published articles