PDF(Pubmed)
Abstract：
Acute pancreatitis (AP) is a common but often self-limiting disease in the majority of patients. However, in the minority, who may progress to moderately severe or severe AP, high mortality risk has been reported. Infected pancreatitis necrosis (IPN) in necrotising pancreatitis has been shown to result in more than twice the mortality rate compared with in sterile pancreatic necrosis. This raises the question on whether prophylactic antibiotics (PABs) should be given in subgroups of AP to prevent superimposed infection to improve survival outcomes. Despite numerous randomised controlled trials (RCTs), meta-analyses, and guidelines on the management of AP, there is a lack of strong evidence to suggest the use of PABs in AP. Additionally, use of PABs is associated with antimicrobial resistance. Considerable heterogeneity exists and limits the interpretation of results-subgroup of AP benefitting from PAB use, choice/class of PAB, and timing of administration from symptom onset and duration of PAB use. Only a minority of existing meta-analyses suggest mortality benefits and reduction in IPN. The majority of existing guidelines do not recommend the use of PABs in AP. More research is required to make more definitive conclusions. Currently, PAB should only be administered after multidisciplinary discussions led by pancreatology experts.
摘要：
在大多数患者中，急性胰腺炎（AP）是一种常见但通常是自限性的疾病。然而,在少数,可能进展为中度或重度AP的人，据报道，高死亡风险。与无菌胰腺坏死相比，坏死性胰腺炎的感染性胰腺炎坏死（IPN）导致的死亡率是其两倍以上。这提出了一个问题，即是否应在AP亚组中给予预防性抗生素（PAB）以预防叠加感染以改善生存结果。尽管有许多随机对照试验(RCT)，荟萃分析，和AP管理指南，缺乏强有力的证据表明在AP中使用PAB。此外,PAB的使用与抗菌药物耐药性相关.存在相当大的异质性，限制了对受益于PAB使用的AP结果亚组的解释，选择/类的PAB，以及从症状发作和PAB使用持续时间开始的给药时间。只有少数现有的荟萃分析表明了死亡率的益处和IPN的减少。大多数现有指南不建议在AP中使用PAB。需要更多的研究来得出更明确的结论。目前,PAB应仅在由胰科专家领导的多学科讨论后进行。
