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Management of acute pancreatitis

BMJ 2004; 328 doi: (Published 22 April 2004) Cite this as: BMJ 2004;328:968
  1. Derek A O'Reilly, specialist registrar in surgery,
  2. Andrew N Kingsnorth, professor of surgery
  1. Aintree University Hospital, Liverpool L9 7AL
  2. Derriford Hospital, Plymouth PL6 8DH

    Role of antibiotics remains controversial

    Acute pancreatitis is a common surgical emergency. The incidence in the United Kingdom has been reported to be as high as 38 per 100 000 per year and increasing. Around 25% of patients develop severe or life threatening complications, requiring support in high dependency or intensive care units. Mortality has fallen from 25-30%, 30 years ago, but has remained at 6-10% for most of the past two decades.1 The initial improvement did not occur because of any specific treatment for acute pancreatitis but because of improved supportive treatment, especially advances in critical care. This supportive treatment may include a role for prophylaxis with antibiotics in acute pancreatitis.

    The rationale for prophylaxis with antibiotics is based on the fact that mortality for infected pancreatic necrosis is higher than that for sterile necrosis, and a potential window of opportunity exists during the first to third weeks for prevention of infection by giving prophylactic antibiotics. A recent Cochrane review supports this view.2 Despite this, the …

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