Acute pancreatitis (OP) is a common condition requiring emergency surgery. The reported frequency of occurrence in the UK is 38 per 100,000 / year and is increasing. About 25% of patients develop serious life-threatening complications when it becomes necessary to go to the intensive care unit and resuscitation. Over the past 30 years, mortality has decreased by 25-30%, but has remained at 6-10% for two decades. This reduction in mortality is not due to the introduction of specific effective treatments for pancreatitis, but as a result of improved supportive care and, in particular, the care of patients in the treatment units. intensive care. The term "maintenance therapy" also means the prophylactic use of OP antibiotics.

The use of antibiotics in acute pancreatitis is based on the fact that mortality in infected pancreatic necrosis is higher than in infertility, and that there is a potential likelihood of decreased mortality when using d 'antibiotic prophylaxis between the first and third week of a PO attack. The recently published Cochrane Systematic Review contains evidence to support this finding. Despite this, the duration of the course and the specific drugs recommended for antibiotic prophylaxis are not well understood. In addition, there is a risk of spreading resistance to the antibiotics used and of developing opportunistic fungal infections. Published data from two new studies do not confirm the benefits of prophylactic use of antibiotics in this nosology.

The practice of prescribing prophylactic antibiotics in OP is omnipresent. The survey, which involved 1,103 surgeons in the UK and Ireland, found that 88% of the 528 respondents prescribed antibiotic prophylaxis, of which 24% applied this regimen to all of their operated patients. It is well known that OPs of moderate severity have a short duration of illness and tend to subside. In this case, the practice of prescribing prophylactic antibiotics to all patients without exception cannot be considered justified. The task of the doctor and the researcher is to identify a group of patients who, thanks to the prophylactic prescription of antibiotics, will improve the outcome of the disease.

Modern guidelines for the management of patients with PO fully reflect the existing contradictions. So, for example, in the manual of the British Gastroenterological Society, there are no specific recommendations for the use of antibiotics for OP. In the practical advice of the American Gastroenterological Society, the initiation of antibiotic therapy in patients with pancreatic necrosis is described as "reasonable". The most recent directive on the surgical treatment of OP published by the International Pancreatological Association can be considered. The lack of evidence on the use of antibiotics for PO, obtained in studies conducted to date, leads to the recommendations published in the above-mentioned guide: the use of antibiotics can reduce the incidence of infection with necrosis pancreatic according to computed tomography, but does not improve survival in this category of patients.

The Cochrane systematic review, led by a research team led by C. Bassi, evaluated 4 of 9 randomized controlled trials evaluating the use of antibiotic prophylaxis in PO. The choice of studies was based on identical inclusion criteria: the presence of pancreatic necrosis, confirmed by computed tomography with contrast enhancement. However, groups of patients could differ in characteristics such as the drugs used, the compatibility of clinical signs, the duration of treatment and the quality of the methodology applied. Of all the studies, none used randomization with a double-blind method. A meta-analysis showed the advantage of antibiotic prophylaxis with two main indicators: overall mortality and the prevalence of infection with pancreatic necrosis. The data obtained allow the study authors to recommend the use of broad-spectrum antibiotics active against pathogens of intra-abdominal infections (cefuroxime, imipenem or ofloxacin in combination with metronidazole) for one to two weeks in patients with pancreatic necrosis.

However, other researchers are questioning the proposed recommendations. In the study by HG Beger et al., Carried out in 1986 (before the introduction of large-scale antibiotic prophylaxis), the majority of isolated microorganisms with infected pancreatic necrosis belonged mainly to the so-called "group of intestinal pathogens "(Escherichia coli and Bacteroides spp.). According to a subsequent study comparing perfloxacin and imipenem in patients with pancreatic necrosis, microbiological analysis showed that the dominant pathogens were methicillin-resistant strains of Staphylococcus aureus and Candida spp. This evolution of pathogens is important evidence that infection with resistant fungi and pathogens is associated with a significant increase in mortality. Obviously, further study of the likely side effects of the widespread prophylactic use of OP antibiotics is needed.

In addition, according to the preliminary results of two randomized controlled trials, the benefit of antibiotic prophylaxis with the nosology discussed cannot be demonstrated. In the first double-blind study led by R. Isenmann et al. the use of ciprofloxacin and metronidazole compared to placebo in patients with severe acute pancreatitis as a preventive measure did not reduce the frequency of infections or mortality. Thus, the authors recommend replacing antibiotic prophylaxis with the prescription of antibiotics "on demand". Here are the specific indications for the appointment of antibiotics:

We may believe that the study under discussion will allow us to formulate a more rational approach to antibiotic prophylaxis in PO.

Despite the existing contradictions, the recommendations, according to the Cochrane review, on the use of broad-spectrum antibiotics active against the agents responsible for intra-abdominal infections in patients with pancreatic necrosis, confirmed by CT scan results within a period of 'one to two weeks, taking into account the existing evidence, can be considered justified. Progress in this area and a decrease in adverse reactions can be expected if new evidence is obtained, and indications for antibiotic prophylaxis in acute pancreatitis will become more specific.