Discuss the role of systemic antibiotic therapy in patients with severe acute pancreatitis
Background / Rationale:
Systemic antibiotics in severe acute pancreatitis (SAP) have a potential role in three areas:
Disadvantages:
Evidence and Practice Guidelines:
Summary statement:
The correct answer to this question is "role? there is none". However, it is a ten-mark SAQ. So, here is an example of how to say "none" using approximately extra 400 words.
Potential uses of antibiotics in pancreatitis
Coincidental treatment of extrapancreatic infection
Treatment of infected pancreatic necrosis
Arguments for the use of prophylactic antibiotics in severe pancreatitis
Counterarguments to the routine use of prophylactic of antibiotics
Evidence
Antibiotic choice (if you felt compelled to give them)
Guidelines and "own practice"
Maheshwari, Rahul, and Ram M. Subramanian. "Severe Acute Pancreatitis and Necrotizing Pancreatitis." Critical care clinics 32.2 (2016): 279-290.
Baltatzis, Minas, et al. "Antibiotic use in acute pancreatitis: Global overview of compliance with international guidelines." Pancreatology (2016).
Parent, Brodie, and E. Patchen Dellinger. "Antibiotic Prophylaxis for Acute Necrotizing Pancreatitis." Difficult Decisions in Hepatobiliary and Pancreatic Surgery. Springer International Publishing, 2016. 433-449.
Tenner, Scott, et al. "American College of Gastroenterology guideline: management of acute pancreatitis." The American journal of gastroenterology 108.9 (2013): 1400-1415.
Jiang, Kun, et al. "Present and future of prophylactic antibiotics for severe acute pancreatitis." World J Gastroenterol 18.3 (2012): 279-84.
Jafri, Nadim S., et al. "Antibiotic prophylaxis is not protective in severe acute pancreatitis: a systematic review and meta-analysis." The American Journal of Surgery 197.6 (2009): 806-813.
Bassi, C., et al. "Behavior of antibiotics during human necrotizing pancreatitis." Antimicrobial agents and chemotherapy 38.4 (1994): 830-836.
Brown, Lisa A., et al. "A systematic review of the extra-pancreatic infectious complications in acute pancreatitis." Pancreatology 14.6 (2014): 436-443.
Larvin, Mike. "Management of infected pancreatic necrosis." Current gastroenterology reports 10.2 (2008): 107-114.
Banks, Peter A. "Pro: computerized tomographic fine needle aspiration (CT-FNA) is valuable in the management of infected pancreatic necrosis." The American journal of gastroenterology 100.11 (2005): 2371.
Pappas, Theodore N. "Con: computerized tomographic aspiration of infected pancreatic necrosis: the opinion against its routine use." The American journal of gastroenterology 100.11 (2005): 2373.
Villatoro, Eduardo, Mubashir Mulla, and Mike Larvin. "Antibiotic therapy for prophylaxis against infection of pancreatic necrosis in acute pancreatitis." The Cochrane Library (2010).