Zusammenfassung
Antibiotika sind bei der schweren akuten Pankreatitis ein elementarer Bestandteil der Therapie. Allerdings sind die Indikationen für ihren Einsatz nach wie vor nicht bis ins Detail geklärt. Gesichert ist, dass die milde akute Pankreatitis keiner Antibiotikaprophylaxe bedarf. Ebenfalls gesichert ist, dass bei infizierten Pankreasnekrosen Breitspektrumantibiotika neben einer chirurgischen oder interventionellen Drainage essenzieller Bestandteil der Therapie sind. Bei der schweren akuten Pankreatitis hat es sich bewährt, anhand bestimmter klinischer Kriterien zu entscheiden, ob Antibiotika gegeben werden. Eine klinische Verschlechterung des Patienten im Verlauf mit ansteigenden laborchemischen Entzündungsparametern oder progredientem Organversagen rechtfertigt die Gabe von Breitspektrumantibiotika, auch wenn der eindeutige wissenschaftliche Beweis für eine positive Beeinflussung des Verlaufes nicht erbracht ist.
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Literatur
Barreda L, Targarona J, Milian W, Portugal J, Sequeiros J, Pando E, Calisto JL (2009) Is the prophylactic antibiotic therapy with Imipenem effective for patients with pancreatic necrosis? Acta Gastroenterol Latinoam 39(1): 24–29
Bassi C, Falconi M, Talamini G, Uomo G, Papaccio G, Dervenis C, Salvia R, Minelli EB, Pederzoli P (1998) Controlled clinical trial of pefloxacin versus imipenem in severe acute pancreatitis. Gastroenterology 115(6): 1513–1517
Beger HG, Bittner R, Block S, Büchler M (1986) Bacterial contamination of pancreatic necrosis. A prospective clinical study. Gastroenterology 91(2): 433–438
Beger HG, Isenmann R (1999) Surgical management of necrotizing pancreatitis. Surg Clin North Am 79: 783–800
Besselink MG, van Santvoort HC, Boermester MA, Nieuwnhuijs VB, van Goor H, Dejong CH, Schaapherder AF, Gooszen HG, Dutch Acute Pancreatitis Study Group (2009) Timing and impact of infections in acute pancreatitis. Br J Surg 96: 267–273
Büchler M, Malfertheiner P, Friess H, Isenmann R, Vanek E, Grimm H, Schlegel P, Friess T, Beger HG (1992) Human pancreatic tissue concentration of bactericidal antibiotics. Gastroenterology 103(6): 1902–1908
Büchler MW, Gloor B, Müller CA, Friess H, Seiler CA, Uhl W (2000) Acute necrotizing pancreatitis: treatment strategy according to the status of infection. Ann Surg 232(5): 619–626
Delcenserie R, Yzet T, Ducroix JP (1996) Prophylactic antibiotics in treatment of severe acute alcoholic pancreatitis. Pancreas 13(2): 198–201
Dellinger EP, Forsmark CE, Layer P, Lévy P, Maraví-Poma E, Petrov MS, Shimosegawa T, Siriwardena AK, Uomo G, Whitcomb DC, Windsor JA; Pancreatitis Across Nations Clinical Research and Education Alliance (PANCREA) (2012) Determinant-based classification of acute pancreatitis severity: an international multidisciplinary consultation. Ann Surg 256: 875–880
Dellinger EP, Tellado JM, Soto NE, Ashley SW, Barie PS, Dugernier T, Imrie CW, Johnson CD, Knaebel HP, Laterre PF, Maravi-Poma E, Kissler JJ, Sanchez-Garcia M, Utzolino S (2007) Early antibiotic treatment for severe acute necrotizing pancreatitis: a randomized, double-blind, placebo-controlled study. Ann Surg 245: 674–683
Eckmann C, Isenmann R, Kujath P, Pross A, Rodloff AC, Schmitz FJ, Trautmann M, Wacha A (2010) Intraabdominelle Infektionen. In: Bodmann K-F, Grabein B Empfehlungen zur kalkulierten parenteralen Initialtherapie bakterieller Erkrankungen bei Erwachsenen – Update 2010. Paul-Ehrlich-Gesellschaft für Chemotherapie, S 46–53
Fritz S, Hackert T, Hartwig W, Rossmanith F, Strobel O, Schneider L, Will-Schweiger K, Kommerell M, Büchler MW, Werner J (2010) Bacterial translocation and infected pancreatic necrosis in acute necrotizing pancreatitis derives from small bowel rather than from colon. Am J Surg 200(1): 111–117
García-Barrasa A, Borobia FG, Pallares R, Jorba R, Poves I, Busquets J, Fabregat J (2009) A double-blind, placebo-controlled trial of ciprofloxacin prophylaxis in patients with acute necrotizing pancreatitis. J Gastrointest Surg 13(4): 768–774
Isenmann R, Rünzi M, Kron M, Kahl S, Kraus D, Jung N, Maier L, Malfertheiner P, Goebell H, Beger HG; German Antibiotics in Severe Acute Pancreatitis Study Group (2004) Prophylactic antibiotic treatment in patients with predicted severe acute pancreatitis: a placebo-controlled, double-blind trial. Gastroenterology 126(4): 997–1004
Jiang K, Huang W, Yang XN, Xia Q (2012) Present and future of prophylactic antibiotics for severe acute pancreatitis. World J Gastroenterol 21: 279–284
Luiten EJ, Hop WC, Lange JF, Bruining HA (1995) Controlled clinical trial of selective decontamination for the treatment of severe acute pancreatitis. Ann Surg 222(1): 57–65
Nordback I, Sand J, Saaristo R, Paajanen H (2001) Early treatment with antibiotics reduces the need for surgery in acute necrotizing pancreatitis – a single-center randomized study. J Gastrointest Surg 5(2): 113–118
Pederzoli P, Bassi C, Vesentini S, Campedelli A (1993) A randomized multicenter clinical trial of antibiotic prophylaxis of septic complications in acute necrotizing pancreatitis with imipenem. Surg Gynecol Obstet 176(5): 480–483
Rau B, Pralle U, Uhl W, Schoenberg MH, Beger HG (1995) Management of sterile necrosis in instances of severe acute pancreatitis. J Am Coll Surg 181(4): 279–288
Røkke O, Harbitz TB, Liljedal J, Pettersen T, Fetvedt T, Heen LØ, Skreden K, Viste A (2007) Early treatment of severe pancreatitis with imipenem: a prospective randomized clinical trial. Scand J Gastroenterol 42(6): 771–776
Rünzi M, Niebel W, Goebell H, Gerken G, Layer P (2005) Severe acute pancreatitis: nonsurgical treatment of infected necroses. Pancreas 30(3): 195–199
Sainio V, Kemppainen E, Puolakkainen P, Taavitsainen M, Kivisaari L, Valtonen V, Haapiainen R, Schröder T, Kivilaakso E (1995) Early antibiotic treatment in acute necrotising pancreatitis. Lancet 346(8976): 663–667
van Santvoort HC, Bakker OJ, Bollen TL, Besselink MG, Ahmed Ali U, Schrijver AM, Boermeester MA, van Goor H, Dejong CH, van Eijck CH, van Ramshorst B, Schaapherder AF, van der Harst E, Hofker S, Nieuwenhuijs VB, Brink MA, Kruyt PM, Manusama ER, van der Schelling GP, Karsten T, Hesselink EJ, van Laarhoven CJ, Rosman C, Bosscha K, de Wit RJ, Houdijk AP, Cuesta MA, Wahab PJ, Gooszen HG; Dutch Pancreatitis Study Group (2011) A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome. Gastroenterology 141(4): 1254–1263
Sawa H, Ueda T, Takeyama Y, Yasuda T, Shinzeki M, Matsumura N, Nakajima T, Matsumoto I, Fujita T, Ajiki T, Fujino Y, Kuroda Y (2007) Treatment outcome of selective digestive decontamination and enteral nutrition in patients with severe acute pancreatitis. J Hepatobiliary Pancreat Surg 14(5): 503–508
Schwarz M, Isenmann R, Meyer H, Beger HG (1997) Antibiotika bei nekrotisierender Pankreatitis – Ergebnisse einer kontrollierten Studie. Dtsch Med Wochenschr 122(12): 356–361
Spicak J, Hejtmankova S, Hubaczova M, Antos F, Bartova J, Cech P et al (2003) Antibiotic prophylaxis of infectious complications of acute pancreatitis – the results of a randomised study by meropenem. Ces Slov Gastroent Hepatol 57: 222–227
Spicak J, Hubaczova M, Antos F, Bartova J, Cech P, Kasalicky M et al (2002) Antibiotics in the treatment of acute pancreatitis-findings from a randomized multi-center prospective study. Ces Slov Gastroent Hepatol 56: 183–189
Villatoro E, Mulla M, Larvin M (2010) Antibiotic tharapy for prophylaxis against infection of pancreatic necrosis in acute pancreatitis. Cochrane Database Syst Rev CD002941
Wittau M, Mayer B, Scheele J, Henne-Bruns D, Dellinger EP, Isenmann R (2011) Systematic review and meta-analysis of antibiotic prophylaxis in severe acute pancreatitis. Scand J Gastroenterol 46(3): 261–270
Xue P, Deng LH, Zhang ZD, Yang XN, Wan MH, Song B, Xia Q (2009) Effect of antibiotic prophylaxis on acute necrotizing pancreatitis: results of a randomized controlled trial. J Gastroenterol Hepatol 24(5): 736–742
Yang X, Deng LH, Xue P, Zhao L, Jin T, Wan M (2009) Non-preventive use of antibiotics in patients with severe acute pancreatitis treated with integrated traditional Chinese and Western therapy: a randomized controlled trial. J Chion Interg Med 7: 330–333
Yao L, Huang X, Li Y, Shi R, Zhang G (2010) Prophylactic antibiotics reduce pancreatic necrosis in acute necrotizing pancreatitis: a meta-analysis of randomized trials. Dig Surg 27: 442–449
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Isenmann, R. (2013). Antibiotikatherapie – selektive Darmdekontamination, was hat sich bei der akuten Pankreatitis bewährt?. In: Beger, H., et al. Erkrankungen des Pankreas. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-37964-2_7
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