Pancreatitis, acute antibiotics

Rifaximin Rifamycin Antibiotic Gut bacteria Enteric infection Diarrhea, infectious Hepatic encephalopathy Small intestine bacterial overgrowth Inflammatory bowel disease Colonic diverticular disease Irritable bowel syndrome Constipation Clostridium difficile infection Helicobacter pylori infection Colorectal surgery Bowel decontamination, selective Pancreatitis, acute Bacterial peritonitis, spontaneous Nonsteroidal anti-inflammatory drug enteropathy... 

Empiric antibiotics are not necessary if the patient has mild disease or a non-infectious etiology of acute pancreatitis. Antibiotics have not been shown to prevent the formation of pancreatic abscess or necrosis when given early in the course of acute pancreatitis. 

Kramer KM, Levy H. Prophylactic antibiotics for severe acute pancreatitis the beginning of an era. Pharmacotherapy 1999 19 592-602. 

Causes of hypocalcemia include hypoparathyroidism, hypomagnesemia, alcoholism, hyperphosphatemia, blood product infusion (due to chelation by the citrate buffers), chronic renal failure, vitamin D deficiency, acute pancreatitis, alkalosis, and hypoalbuminemia. Medications that cause hypocalcemia include phosphate replacement products, loop diuretics, phenytoin (Dilantin, available as generic), pheno-barbital (available as generic), corticosteroids, aminoglycoside antibiotics, and acetazolamide (available as generic).34,39,42... 

In addition to ANP where it is associated with GI dys-motility [198, 199], SIBO is present in a significant proportion of patients with chronic pancreatitis [200, 201], Short-term rifaximin therapy was able to normalize the hydrogen breath test and improve symptoms (i.e. diarrhea and fecal fat excretion) in all patients studied (fig. 9) [201]. Bowel decontamination via administration of this topical antibiotic could, therefore, be beneficial in both acute and chronic pancreatitis. Double-blind, placebo-controlled studies are to be performed to explore the rifaximin potential in this indication. 

Sharma VK, Howden CW Prophylactic antibiotic administration reduces sepsis and mortality in acute necrotizing pancreatitis A meta-analysis. Pancreas 2001 22 28-31. 

R, Runzi 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 Prophylactic antibiotic treatment in patients with predicted severe acute pancreatitis A placebo-con-trolled, double-blind trial. Gastroenterology 2004 126 997-1004. 

Marotta F, Geng TC, Wu CC, Barbi G Bacterial translocation in the course of acute pancreatitis Beneficial role of nonabsorbable antibiotics and lactitol enemas. Digestion 1996 57 446-452. 

Antibiotics should not be used in the absence of signs of infection except in patients with severe acute pancreatitis when pancreatic necrosis is present. 

At present there is sufficient evidence to recommend that patients with severe acute necrotizing pancreatitis should receive antibiotic prophylaxis as soon as possible after diagnosis. Three... 

Saitiio V, Kemppainen P, Poulallainen P, et al. Early antibiotic treatment in acute necrotizing pancreatitis. Lancet 1995 346 663-667. 

Delcenserie R, Yzet T, Ducroix JR Prophylactic antibiotics in treatment of severe acute alcohohc pancreatitis. Pancreas 1996 13 198-201. 

Golub R, Siddiai F, Pohl D. Role of antibiotics in acute pancreatitis A meta-analysis. J Gastrointest Surg 1998 2 496-503... 

Howard TJ, Temple MB. Prophylactic antibiotics alter the bacteriology of infected necrosis in severe acute pancreatitis. J Am Coll Surg 2002 195 759-767. 

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