Fretland Asmund Avdem
Det medisinske fakultet, Universitetet i Oslo og Sykehuset Innlandet Hamar, 2307 Hamar.
Tidsskr Nor Laegeforen. 2005 May 19;125(10):1323-5.
Randomized controlled trials on acute necrotizing pancreatitis suggest that prophylactic antibiotics can reduce mortality and morbidity in these patients by preventing pancreatic infections.
Relevant articles were assessed using a clinical appraisal skills programme.
Eight trials have been published since 1990. The early trials showed that prophylactic antibiotics did reduce mortality and morbidity; however, errors of methodology weaken these results. In later trials results have varied: in September 2004, Isenmann et al. published a trial with a greatly improved design and found no effect of prophylactic antibiotics compared to antibiotic treatment on demand.
Based on the results obtained so far, the evidence is not yet strong enough to recommend prophylactic antibiotics in acute necrotizing pancreatitis. There is still a need for a new, larger, multicentre study that pays careful attention to all aspects of the condition, for instance diagnosis and treatment of abdominal compartment syndrome, and guidelines for method and time of surgery.
关于急性坏死性胰腺炎的随机对照试验表明，预防性使用抗生素可通过预防胰腺感染降低这些患者的死亡率和发病率。
使用临床评估技能程序对相关文章进行评估。
自1990年以来已发表八项试验。早期试验表明预防性使用抗生素确实降低了死亡率和发病率；然而，方法学上的错误削弱了这些结果。在后来的试验中结果各不相同：2004年9月，伊森曼等人发表了一项设计有很大改进的试验，发现与按需使用抗生素治疗相比，预防性使用抗生素没有效果。
根据目前获得的结果，证据尚不足以推荐在急性坏死性胰腺炎中使用预防性抗生素。仍需要一项新的、更大规模的多中心研究，该研究要仔细关注病情的各个方面，例如腹腔间隔室综合征的诊断和治疗，以及手术方法和时间的指南。
