Present and future of prophylactic antibiotics for severe acute pancreatitis

2012

Kun Jiang, Wei Huang, Xiao-Nan Yang, and Qing Xia

Author information ► Article notes ► Copyright and License information 

Abstract

AIM: 

To investigate the role of prophylactic antibiotics in the reduction of mortality of severe acute pancreatitis (SAP) patients, which is highly questioned by more and more randomized controlled trials (RCTs) and meta-analyses.

METHODS: 

An updated meta-analysis was performed. RCTs comparing prophylactic antibiotics for SAP with control or placebo were included for meta-analysis. The mortality outcomes were pooled for estimation, and re-pooled estimation was performed by the sensitivity analysis of an ideal large-scale RCT.

RESULTS:

Currently available 11 RCTs were included. Subgroup analysis showed that there was significant reduction of mortality rate in the period before 2000, while no significant reduction in the period from 2000 [Risk Ratio, (RR) = 1.01, P = 0.98]. Funnel plot indicated that there might be apparent publication bias in the period before 2000. Sensitivity analysis showed that the RR of mortality rate ranged from 0.77 to 1.00 with a relatively narrow confidence interval (P < 0.05). However, the number needed to treat having a minor lower limit of the range (7-5096 patients) implied that certain SAP patients could still potentially prevent death by antibiotic prophylaxis.

CONCLUSION:

Current evidences do not support prophylactic antibiotics as a routine treatment for SAP, but the potentially benefited sub-population requires further investigations.

NIH-World Journal of Gastroenterology

Current concepts of prophylactic antibiotics in trauma: a review.

2012

Lane JC, Mabvuure NT, Hindocha S, Khan W.

Source

Department of Plastic Surgery, Guy's and St Thomas's Hospital, Westminster Bridge Road, London SE1 7EH, UK.

Abstract

Traumatic injuries cause 5.8 million deaths per year globally. Before the advent of antibiotics, sepsis was considered almost inevitable after injury. Today infection continues to be a common complication after traumatic injury and is associated with increases in morbidity and mortality and longer hospital stays. Research into the prevention of post-traumatic infection has predominantly focused on thoracic and abdominal injuries. In addition, because research on sepsis following musculoskeletal injuries has predominantly been on open fractures. There is a paucity of research into the prevention of soft tissue infections following traumatic injuries. This review analyses the evidence for the role of prophylactic antibiotics in the management of soft tissue injuries. Emphasis is placed on assessing the strength of the presented evidence according to the Oxford Level of Evidence scale.

PubMed

Zinc plus antibiotics saves lives of children with pneumonia, study finds

Zinc plus antibiotics saves lives of children with pneumona, study finds

Publish date: Feb 24, 2012
By: Formulary staff

Zinc used in addition to antibiotics significantly reduced mortality in children ages 6 months to 59 months with severe pneumonia when compared with antibiotics alone, according to the findings of a recent study done in Uganda.

The study, published online February 8 in BMC Medicine, also indicated that the adjunct therapy had a greater effect among HIV-infected children than those who were not infected with HIV.

The double-blind, randomized, placebo-controlled study was led by Maheswari G. Srinivasan, from the Department of Pediatrics and Child Health at the School of Medicine, in Uganda. Researchers enrolled 352 children, aged 6 months to 59 months, who were admitted to the Mulago Hospital pediatric emergency ward with severe pneumonia between September 2006 and March 2007.

"There are 2 key findings in this study: overall, zinc supplementation in these children significantly decreased case fatality, but did not reduce the time to normalization of the parameters for disease severity," the authors stated, noting that these findings come from the secondary objective rather than the primary objectives, which were to assess the effect of zinc as an adjunct therapy on time to normalization of respiratory rate, temperature, and oxygen saturation.

The investigators randomly assigned the children to receive standard antibiotic therapy plus zinc (10 mg for children aged under 12 months; 20 mg for children 12 months and older) or standard antibiotic therapy plus placebo daily. The children were assessed every 6 hours for the first 48 hours and then every 12 hours for 7 days of treatment.

The investigators found no evidence that zinc decreased length of time to recovery. They did, however, note the number of deaths was lower among the children who were treated with zinc (4.0% vs 11.9%; RR=0.33; 95% CI, 0.15-0.76).

In addition, the researchers noted that the effect of zinc supplementation appeared stronger among children infected with HIV. There were more deaths among HIV-positive children assigned to placebo compared with those who received zinc (25.9% vs 0%; RR=0.1; 95% CI, 0.0-1.0).

Among those children who were not infected with HIV and who received placebo, the death rate was 5.5% versus 3.9% among HIV-uninfected children who received zinc (RR=0.7; 95% CI, 0.2-2.2).

“Acute respiratory tract infections are the most common cause of morbidity and deaths in children less than 5 years,” the authors wrote in their background. “Given these results,” the authors stated, “zinc could be considered for use as adjunct therapy for severe pneumonia, especially among Highly Active Antiretroviral Therapy-naïve, HIV-infected children in our environment.”

Modern Medicine