Comparing the Outcome in Patients of Acute Pancreatitis, With and Without Prophylactic Antibiotics
Condition: Acute Pancreatitis
MeSH terms: Pancreatitis
Study type: Interventional
Phase: Phase 1/Phase 2

Summary: 
      The use of prophylactic antibiotics is beneficial in reducing the extrapancreatic infections
      and shorter hospital stay in patients of acute pancreatitis as compared to controls.
    

Detailed description: 
      Acute pancreatitis (AP) is an acute inflammatory condition of the pancreas that may extend to
      local and distant extra pancreatic tissues. AP is broadly classified as mild or severe. Most
      cases of AP are mild with excellent recovery. However 15% to 20% are severe. Bacterial
      infections play a vital in the course of the disease. Patients with AP are prone to develop
      extrapancreatic infections like urinary, respiratory and systemic infections. These
      infections may result in a prolonged hospitalization, systemic inflammatory response syndrome
      (SIRS), multi-organ system failure and death. The most common causes are gallstones and
      alcohol intake. AP is managed by intravenous fluids, analgesia and nothing by mouth. However
      treatment of severe pancreatitis can be challenging, particularly if multiple organ systems
      are involved or if there are local complications. In severe acute pancreatitis, as pancreatic
      enzymes and inflammatory mediators damage the blood vessels and leads to extravasation of
      fluid in to third space. This fluid extravasation leads to local pancreatic necrosis and
      end-organ failure. Assessment of severity begins in the emergency room or on admission. Signs
      of SIRS (high or low core body temperature, tachycardia, tachypnea, low or high peripheral
      white blood cell count) or organ failure (e.g. elevated serum creatinine) are present on
      admission in 21% of patients with acute pancreatitis. CT should be considered about 3 days
      after the onset of symptoms rather than immediately upon admission. Eighty per cent of cases
      of AP are interstitial and mild; the remaining 20% are necrotizing and severe.

      The role of prophylactic antibiotics in acute pancreatitis is controversial .A study
      published in American Journal of Gastroenterology shows results favouring use of antibiotics
      in acute pancreatitis. This study shows significant reduction in the length of
      hospitalization in patients who were given prophylactic antibiotics.

      Other Internationally conducted studies suggests that there is no or insignificant role of
      antibiotics for mild acute pancreatitis and role of prophylactic antibiotics in sever acute
      pancreatitis for better clinical outcome is controversial to say the least.

      Rationale of this study was to emphasize that prophylactic antibiotics in patients with acute
      pancreatitis can improve patient's out come in terms of shorter hospital stay, and reduced
      number of extrapancreatic infections.
    

Intervention name(s): Meropenem
Intervention type(s): Drug
Intervention description(s): inj. MEROPENEM IV 1 gram twice daily at 12 hours interval for 7-10 days
Intervention MeSH terms: Meropenem
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Care Provider)
Primary purpose: Treatment
Keywords: acute pancreatitis