Antibiotic prophylaxis in severe acute pancreatitis: randomised multicenter prospective trial with meropenem

Nowadays, most deaths in acute pancreatitis are caused by infection, thus the role of prophylaxis of infectious complications in severe acute pancreatitis (SAP) still remains a debatable issue. AIM: The aim of the study was to assess the efficacy of prophylactic antibiotic treatment comparing rates of local and infectious complications, mean hospital stay, necessity of surgical treatment and mortality in two groups of patients with SAP. METHODS: Fourty one patients with SAP were enrolled into the randomized multicenter prospective study according to the clinical criteria defined at the Atlanta symposium, necrotizing pancreatitis on CT or CRP level exceeding 190 mg/l. The patients were randomized either into the prophylactic (P) or into the therapeutic (T) group. In the P-group, meropenem 500 mg was administrated every 8 hours for 10 days. In the T-group, the patients received the same antibiotics only in the case of confirmed infectious complications (infected necrosis, abscess, urinary infection, pneumonia, etc.). CONCLUSIONS: Prophylactic antibiotic treatment did not reduce neither the rate of infectious complications nor mortality and other criteria in patients with SAP. Concluding from our results, we cannot recommend the routine antibiotic prophylaxis in patients with SAP.