Chan Kai Siang, Shelat Vishal G
Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore.
Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore.
Antibiotics (Basel). 2024 Apr 30;13(5):411. doi: 10.3390/antibiotics13050411.
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.
急性胰腺炎（AP）在大多数患者中是一种常见但通常自限性的疾病。然而，少数可能进展为中度或重度AP的患者报告有较高的死亡风险。坏死性胰腺炎中的感染性胰腺坏死（IPN）与无菌性胰腺坏死相比，死亡率高出两倍多。这就引发了一个问题，即在AP的亚组中是否应给予预防性抗生素（PABs）以预防叠加感染从而改善生存结果。尽管有众多关于AP管理的随机对照试验（RCTs）、荟萃分析和指南，但缺乏有力证据支持在AP中使用PABs。此外，使用PABs与抗菌药物耐药性相关。存在相当大的异质性，限制了对结果的解释——从PABs使用中获益的AP亚组、PABs的选择/类别以及从症状发作开始的给药时间和PABs的使用持续时间。现有的荟萃分析中只有少数表明对死亡率有益并能减少IPN。大多数现有指南不建议在AP中使用PABs
