The efficacy of different modes of antibiotic prophylaxis in the prevention of complications in severe acute pancreatitis

Introduction: Prophylactic administration of broad-spectrum antibiotics in severe acute pancreatitis (AP) still remains controversial. Aim of study: The aim of the study was to compare the clinical efficacy of piperacillin with tazobactam, ciprofloxacin with metronidazole and meropenem in the prevention of severe acute pancreatitis complications. Material and methods: A total of 119 patients were enrolled in the study. Group A (N=38) received piperacillin/tazobactam, group B (N=47) - ciprofloxacin/metronidazole, and group C - meropenem (N=34). The evaluation of the disease severity was based on: the Atlanta classification, serum C-reactive protein, Ranson's criteria, Apache II score and Balthazar's score. Primary end points of the study were the incidents of pancreatic and extrapancreatic complications of AP. Secondary end points of the study were mortality, number of patients who needed surgical treatment, duration of hospitalization. Results: Overall, clinical improvement was observed in 95 patients (79.8%) and 5 patients (4.2%) have died. Among 14 patients (11.8%) who required surgical treatment, 8 patients originated from group B. The incidence of local complications in group A, B and C was 42%, 46.8% and 47.1%, respectively. Although, there was no significant difference, systemic complications occurred more often in patients who received ciprofloxacin/ metronidazole compared to group A and C (61% vs 44.7% and 47%). Conclusions: The study showed no significant differences, in the rate of local and systemic complications of severe AP between three different modes of antibiotic prophylaxis. However, piperacillin/tazobactam and meropenem seem to be superior to ciprofloxacin/ metronidazole.