Efficacy of Prophylactic use of Ciprofloxacin and Metronidazole in Mild and Moderately Severe Acute Pancreatitis

  • Amrendra Kumar Mandal Gastroenterology Unit, Department of Medicine, NAMS, Bir Hospital, Kathmandu, Nepal
  • Sitaram Chaudhary Gastroenterology Unit, Department of Medicine, NAMS, Bir Hospital, Kathmandu, Nepal
  • Barun Shrestha Gastroenterology Unit, Department of Medicine, NAMS, Bir Hospital, Kathmandu, Nepal
  • Mukesh Sharma Paudel Gastroenterology Unit, Department of Medicine, NAMS, Bir Hospital, Kathmandu, Nepal
  • Nandu Silwal Paudel Gastroenterology Unit, Department of Medicine, NAMS, Bir Hospital, Kathmandu, Nepal
  • Bidhan Nidhi Paudel Gastroenterology Unit, Department of Medicine, NAMS, Bir Hospital, Kathmandu, Nepal
  • Bikash Bhattarai Interfaith Medical Center, Brooklyn, NY, USA
  • Sunil Kumar Ray Sure Medical PC, Elmhurst, NY, USA
  • Neetu Mandal Ray New York Presbyterian Hospital, Queens, NY, USA
Keywords: Keywords: mild acute pancreatitis; moderately severe acute pancreatitis; prophylactic antibiotics; Atlanta classification 2012.


Introduction: There are new concepts and developments in the diagnosis and management of acute pancreatitis. Current evidence suggests that there is no role of prophylactic antibiotics use in acute pancreatitis. However, it is still a common practice to administer prophylactic antibiotics in a country like Nepal. So, we have conducted a study in mild and moderately severe acute pancreatitis to study the efficacy of prophylactic antibiotics.
Methods: A case control study was conducted among 76 patients comparing efficacy of prophylactic antibiotics versus no antibiotics in patients with mild and moderately severe acute pancreatitis.
Results: The two most common etiology of acute pancreatitis in AG and NAG were alcohol 21 (55.2%) vs. 24 (63.1%) and biliary 10 (26.3%) vs. 4 (10.5%) respectively. Pancreatic necrosis was seen in five (13.1 %) in AG and four (10.5%) in NAG. Four (10.5%) developed extra pancreatic complications in AG and five (13.1%) in NAG. There was one (2.6%) death in AG and no death in NAG. Abdominal pain improvement seen in AG vs. NAG was 3.2 days vs. 2.4 days (p =0.002). The hospital stay was 7.7±2.23 days in AG and 7.5±1.85 days in NAG (p=0.65).
Conclusions: The routine use of prophylactic antibiotics for mild and moderately severe acute pancreatitis is not associated with improvement in meaningful clinical outcomes.
Keywords: Atlanta classification 2012; mild acute pancreatitis; moderately severe acute pancreatitis; prophylactic antibiotic. [PubMed]


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