Cinar Esref, Ateskan Umit, Baysan Abdullah, Mas Mehmet Refik, Comert Bilgin, Yasar Mehmet, Ozyurt Mustafa, Yener Nuran, Mas Nuket, Ozkomur Esber, Altinatmaz Kemal
Department of Infectious Diseases, Gulhane School of Medicine, Ankara, Turkey.
Pancreatology. 2003;3(5):383-8. doi: 10.1159/000073653. Epub 2003 Sep 24.
Secondary infection of the inflamed pancreas is the principal cause of death after severe acute pancreatitis (AP). Although patients are not always managed early in the course of AP in clinical practice, prophylactic antibiotics that were used in experimental studies in rats were always initiated early after induction of pancreatitis. The effectiveness of antibiotics initiated later is unknown.
The aim of this study was to compare the effectiveness of ciprofloxacin and meropenem initiated early versus later in the course of acute necrotizing pancreatitis (ANP) in rats.
100 Sprague-Dawley rats were studied. ANP was induced in rats by intraductal injection of 3% taurocholate. Rats were divided randomly into five groups: group I rats received normal saline as a placebo, group II and IV rats received three times daily meropenem 60 mg/kg i.p. at 2 and 24 h, respectively and group III and V rats received twice daily ciprofloxacin 50 mg/kg i.p. at 2 and 24 h, respectively, after induction. At 96 h, all rats were killed for quantitative bacteriologic study. A point-scoring system of histological features was used to evaluate the severity of pancreatitis.
Meropenem and ciprofloxacin initiated 2 h after induction of pancreatitis significantly reduced the prevalence of pancreatic infection (p < 0.001 and p < 0.04, respectively) as compared to controls. Neither of the antibiotics initiated later during the course of AP caused a significant decrease in pancreatic infection in rats (p > 0.05). Although the rats treated early infected less frequently than the rats treated later, the comparison reached statistical significance only in the meropenem group (p < 0.02).
Early antibiotic treatment reduces pancreatic infection more efficiently than late antibiotic treatment in ANP in rats.
胰腺炎症的继发性感染是重症急性胰腺炎（AP）后死亡的主要原因。尽管在临床实践中患者并非总是在AP病程早期就得到治疗，但在大鼠实验研究中使用的预防性抗生素总是在胰腺炎诱导后早期开始使用。后期开始使用抗生素的有效性尚不清楚。
本研究的目的是比较环丙沙星和美罗培南在大鼠急性坏死性胰腺炎（ANP）病程中早期与后期使用的有效性。
对100只Sprague-Dawley大鼠进行研究。通过胰管内注射3%牛磺胆酸钠诱导大鼠发生ANP。大鼠被随机分为五组：I组大鼠接受生理盐水作为安慰剂，II组和IV组大鼠分别在诱导后2小时和24小时腹腔注射美罗培南60mg/kg，每日3次，III组和V组大鼠分别在诱导后2小时和24小时腹腔注射环丙沙星50mg/kg，每日2次。在96小时时，处死所有大鼠进行定量细菌学研究。采用组织学特征评分系统评估胰腺炎的严重程度。
与对照组相比，胰腺炎诱导后2小时开始使用美罗培南和环丙沙星可显著降低胰腺感染的发生率（分别为p<0.001和p<0.04）。在AP病程后期开始使用的两种抗生素均未导致大鼠胰腺感染显著减少（p>0.05）。尽管早期治疗的大鼠感染频率低于后期治疗的大鼠，但仅在美罗培南组比较达到统计学意义（p<0.02）。
在大鼠ANP中，早期抗生素治疗比晚期抗生素治疗更有效地减少胰腺感染。
