Antibiotic use in acute pancreatitis

An Indian multicenter observational study

Rupjyoti Talukdar, Pankaj Ingale, Hrushikesh P. Choudhury, Rajan Dhingra, Shiran Shetty, Harshad Joshi, K. R. Pradeep, Lalatendu Mahapatra, Subhasish Mazumder, J. K. Pradeep, Bhavesh Thakker, Adarsh Chaudhary, Ajay Kumar, D. Nageshwar Reddy, G. V. Rao, H. Ramesh, Naresh Bhat, Pramod Garg, Rakesh Kochhar

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Introduction: Prophylactic antibiotics are used frequently for acute pancreatitis (AP). Consensus guidelines do not recommend this currently, based on moderate quality evidence. In this study, we aimed to evaluate the antibiotic use pattern in AP in India and propose a risk-directed approach to antibiotic use in AP.

Material and Methods: This multicenter study was conducted from 1 May 2013 to 31 July 2013. Eleven participants from eight tertiary centers completed a questionnaire that captured patient demographics, etiology, admission status, presence of (peri)pancreatic necrosis, severity of pancreatitis, details of antibiotic use, and clinical outcomes (total hospital stay, persistent organ failure, need for ICU, total days in ICU, development of infections, in-hospital mortality).

Results: A total of 200 proformas were analyzed. Seventy-three (36.5 %) had acute necrotizing pancreatitis (ANP). Eighty-nine (44.5 %), 52 (26 %), and 55 (27.5 %) patients had mild AP (MAP), moderately severe AP (MSAP), and severe AP (SAP), respectively. Forty-five (22.5 %) patients developed infections (unifocal 29; multifocal 16). One hundred thirty-four (67 %) patients received antibiotics, of which 89 (66.4 %) received prophylactic, while 45 (33.6 %) received therapeutic antibiotics. The distribution of antibiotic use according to the severity of AP was 43 (48.3 %) in patients with MAP (prophylactic in 41; therapeutic in 2), 36 (69.2 %) in patients with MSAP (prophylactic in 29; therapeutic in 7), and 55 (100 %) in patients with SAP (prophylactic in 19; therapeutic in 36). Therapeutic antibiotics were prescribed based on culture and sensitivity in 21 (46.7 %) patients.

Conclusions: Despite nonrecommendation, prophylactic antibiotics are used frequently in AP. We emphasize on the need for multicenter randomized controlled trials on prophylactic antibiotics for AP based on a risk-directed approach, rather than a “blanket approach”.

Original languageEnglish
Pages (from-to)458-465
Number of pages8
JournalIndian Journal of Gastroenterology
Volume33
Issue number5
DOIs
Publication statusPublished - 01-09-2014

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Pancreatitis
Multicenter Studies
Observational Studies
Anti-Bacterial Agents
Acute Necrotizing Pancreatitis
Therapeutics
Hospital Mortality
Infection
India
Length of Stay
Necrosis
Randomized Controlled Trials
Demography
Guidelines

All Science Journal Classification (ASJC) codes

  • Gastroenterology

Cite this

Talukdar, R., Ingale, P., Choudhury, H. P., Dhingra, R., Shetty, S., Joshi, H., ... Kochhar, R. (2014). Antibiotic use in acute pancreatitis: An Indian multicenter observational study. Indian Journal of Gastroenterology, 33(5), 458-465. https://doi.org/10.1007/s12664-014-0494-7
Talukdar, Rupjyoti ; Ingale, Pankaj ; Choudhury, Hrushikesh P. ; Dhingra, Rajan ; Shetty, Shiran ; Joshi, Harshad ; Pradeep, K. R. ; Mahapatra, Lalatendu ; Mazumder, Subhasish ; Pradeep, J. K. ; Thakker, Bhavesh ; Chaudhary, Adarsh ; Kumar, Ajay ; Reddy, D. Nageshwar ; Rao, G. V. ; Ramesh, H. ; Bhat, Naresh ; Garg, Pramod ; Kochhar, Rakesh. / Antibiotic use in acute pancreatitis : An Indian multicenter observational study. In: Indian Journal of Gastroenterology. 2014 ; Vol. 33, No. 5. pp. 458-465.
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abstract = "Introduction: Prophylactic antibiotics are used frequently for acute pancreatitis (AP). Consensus guidelines do not recommend this currently, based on moderate quality evidence. In this study, we aimed to evaluate the antibiotic use pattern in AP in India and propose a risk-directed approach to antibiotic use in AP.Material and Methods: This multicenter study was conducted from 1 May 2013 to 31 July 2013. Eleven participants from eight tertiary centers completed a questionnaire that captured patient demographics, etiology, admission status, presence of (peri)pancreatic necrosis, severity of pancreatitis, details of antibiotic use, and clinical outcomes (total hospital stay, persistent organ failure, need for ICU, total days in ICU, development of infections, in-hospital mortality).Results: A total of 200 proformas were analyzed. Seventy-three (36.5 {\%}) had acute necrotizing pancreatitis (ANP). Eighty-nine (44.5 {\%}), 52 (26 {\%}), and 55 (27.5 {\%}) patients had mild AP (MAP), moderately severe AP (MSAP), and severe AP (SAP), respectively. Forty-five (22.5 {\%}) patients developed infections (unifocal 29; multifocal 16). One hundred thirty-four (67 {\%}) patients received antibiotics, of which 89 (66.4 {\%}) received prophylactic, while 45 (33.6 {\%}) received therapeutic antibiotics. The distribution of antibiotic use according to the severity of AP was 43 (48.3 {\%}) in patients with MAP (prophylactic in 41; therapeutic in 2), 36 (69.2 {\%}) in patients with MSAP (prophylactic in 29; therapeutic in 7), and 55 (100 {\%}) in patients with SAP (prophylactic in 19; therapeutic in 36). Therapeutic antibiotics were prescribed based on culture and sensitivity in 21 (46.7 {\%}) patients.Conclusions: Despite nonrecommendation, prophylactic antibiotics are used frequently in AP. We emphasize on the need for multicenter randomized controlled trials on prophylactic antibiotics for AP based on a risk-directed approach, rather than a “blanket approach”.",
author = "Rupjyoti Talukdar and Pankaj Ingale and Choudhury, {Hrushikesh P.} and Rajan Dhingra and Shiran Shetty and Harshad Joshi and Pradeep, {K. R.} and Lalatendu Mahapatra and Subhasish Mazumder and Pradeep, {J. K.} and Bhavesh Thakker and Adarsh Chaudhary and Ajay Kumar and Reddy, {D. Nageshwar} and Rao, {G. V.} and H. Ramesh and Naresh Bhat and Pramod Garg and Rakesh Kochhar",
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Talukdar, R, Ingale, P, Choudhury, HP, Dhingra, R, Shetty, S, Joshi, H, Pradeep, KR, Mahapatra, L, Mazumder, S, Pradeep, JK, Thakker, B, Chaudhary, A, Kumar, A, Reddy, DN, Rao, GV, Ramesh, H, Bhat, N, Garg, P & Kochhar, R 2014, 'Antibiotic use in acute pancreatitis: An Indian multicenter observational study', Indian Journal of Gastroenterology, vol. 33, no. 5, pp. 458-465. https://doi.org/10.1007/s12664-014-0494-7

Antibiotic use in acute pancreatitis : An Indian multicenter observational study. / Talukdar, Rupjyoti; Ingale, Pankaj; Choudhury, Hrushikesh P.; Dhingra, Rajan; Shetty, Shiran; Joshi, Harshad; Pradeep, K. R.; Mahapatra, Lalatendu; Mazumder, Subhasish; Pradeep, J. K.; Thakker, Bhavesh; Chaudhary, Adarsh; Kumar, Ajay; Reddy, D. Nageshwar; Rao, G. V.; Ramesh, H.; Bhat, Naresh; Garg, Pramod; Kochhar, Rakesh.

In: Indian Journal of Gastroenterology, Vol. 33, No. 5, 01.09.2014, p. 458-465.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Antibiotic use in acute pancreatitis

T2 - An Indian multicenter observational study

AU - Talukdar, Rupjyoti

AU - Ingale, Pankaj

AU - Choudhury, Hrushikesh P.

AU - Dhingra, Rajan

AU - Shetty, Shiran

AU - Joshi, Harshad

AU - Pradeep, K. R.

AU - Mahapatra, Lalatendu

AU - Mazumder, Subhasish

AU - Pradeep, J. K.

AU - Thakker, Bhavesh

AU - Chaudhary, Adarsh

AU - Kumar, Ajay

AU - Reddy, D. Nageshwar

AU - Rao, G. V.

AU - Ramesh, H.

AU - Bhat, Naresh

AU - Garg, Pramod

AU - Kochhar, Rakesh

PY - 2014/9/1

Y1 - 2014/9/1

N2 - Introduction: Prophylactic antibiotics are used frequently for acute pancreatitis (AP). Consensus guidelines do not recommend this currently, based on moderate quality evidence. In this study, we aimed to evaluate the antibiotic use pattern in AP in India and propose a risk-directed approach to antibiotic use in AP.Material and Methods: This multicenter study was conducted from 1 May 2013 to 31 July 2013. Eleven participants from eight tertiary centers completed a questionnaire that captured patient demographics, etiology, admission status, presence of (peri)pancreatic necrosis, severity of pancreatitis, details of antibiotic use, and clinical outcomes (total hospital stay, persistent organ failure, need for ICU, total days in ICU, development of infections, in-hospital mortality).Results: A total of 200 proformas were analyzed. Seventy-three (36.5 %) had acute necrotizing pancreatitis (ANP). Eighty-nine (44.5 %), 52 (26 %), and 55 (27.5 %) patients had mild AP (MAP), moderately severe AP (MSAP), and severe AP (SAP), respectively. Forty-five (22.5 %) patients developed infections (unifocal 29; multifocal 16). One hundred thirty-four (67 %) patients received antibiotics, of which 89 (66.4 %) received prophylactic, while 45 (33.6 %) received therapeutic antibiotics. The distribution of antibiotic use according to the severity of AP was 43 (48.3 %) in patients with MAP (prophylactic in 41; therapeutic in 2), 36 (69.2 %) in patients with MSAP (prophylactic in 29; therapeutic in 7), and 55 (100 %) in patients with SAP (prophylactic in 19; therapeutic in 36). Therapeutic antibiotics were prescribed based on culture and sensitivity in 21 (46.7 %) patients.Conclusions: Despite nonrecommendation, prophylactic antibiotics are used frequently in AP. We emphasize on the need for multicenter randomized controlled trials on prophylactic antibiotics for AP based on a risk-directed approach, rather than a “blanket approach”.

AB - Introduction: Prophylactic antibiotics are used frequently for acute pancreatitis (AP). Consensus guidelines do not recommend this currently, based on moderate quality evidence. In this study, we aimed to evaluate the antibiotic use pattern in AP in India and propose a risk-directed approach to antibiotic use in AP.Material and Methods: This multicenter study was conducted from 1 May 2013 to 31 July 2013. Eleven participants from eight tertiary centers completed a questionnaire that captured patient demographics, etiology, admission status, presence of (peri)pancreatic necrosis, severity of pancreatitis, details of antibiotic use, and clinical outcomes (total hospital stay, persistent organ failure, need for ICU, total days in ICU, development of infections, in-hospital mortality).Results: A total of 200 proformas were analyzed. Seventy-three (36.5 %) had acute necrotizing pancreatitis (ANP). Eighty-nine (44.5 %), 52 (26 %), and 55 (27.5 %) patients had mild AP (MAP), moderately severe AP (MSAP), and severe AP (SAP), respectively. Forty-five (22.5 %) patients developed infections (unifocal 29; multifocal 16). One hundred thirty-four (67 %) patients received antibiotics, of which 89 (66.4 %) received prophylactic, while 45 (33.6 %) received therapeutic antibiotics. The distribution of antibiotic use according to the severity of AP was 43 (48.3 %) in patients with MAP (prophylactic in 41; therapeutic in 2), 36 (69.2 %) in patients with MSAP (prophylactic in 29; therapeutic in 7), and 55 (100 %) in patients with SAP (prophylactic in 19; therapeutic in 36). Therapeutic antibiotics were prescribed based on culture and sensitivity in 21 (46.7 %) patients.Conclusions: Despite nonrecommendation, prophylactic antibiotics are used frequently in AP. We emphasize on the need for multicenter randomized controlled trials on prophylactic antibiotics for AP based on a risk-directed approach, rather than a “blanket approach”.

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