meropenem and Pancreatitis

The management of acute pancreatitis (AP) is still based on speculative and unproven paradigms in many centers. Therefore, we performed an evidence-based analysis to assess the best available treatment.. A comprehensive Medline and Cochrane Library search was performed evaluating the indication and timing of interventional and surgical approaches, and the value of aprotinin, lexipafant, gabexate mesylate, and octreotide treatment. Each study was ranked according to the evidence-based methodology of Sackett; whenever feasible, we performed new meta-analyses using the random-effects model. Recommendations were based on the available level of evidence (A=large randomized; B=small randomized; C=prospective trial).. None of the evaluated medical treatments is recommended (level A). Patients with AP should receive early enteral nutrition (level B). While mild biliary AP is best treated by primary cholecystectomy (level B), patients with severe biliary AP require emergency endoscopic papillotomy followed by interval cholecystectomy (level A). Patients with necrotizing AP should receive imipenem or meropenem prophylaxis to decrease the risk of infected necrosis and mortality (level A). Sterile necrosis per se is not an indication for surgery (level C), and not all patients with infected necrosis require immediate surgery (level B). In general, early necrosectomy should be avoided (level B), and single necrosectomy with postoperative lavage should be preferred over "open-packing" because of fewer complications with comparable mortality rates (level C).. While providing new insights into key aspects of AP management, this evidence-based analysis highlights the need for further clinical trials, particularly regarding the indications for antibiotic prophylaxis and surgery.

Topics: Acute Disease; Anti-Bacterial Agents; Antibiotic Prophylaxis; Aprotinin; Cholecystectomy; Enteral Nutrition; Evidence-Based Medicine; Gabexate; Gastrointestinal Agents; Humans; Imidazoles; Imipenem; Leucine; Meropenem; Octreotide; Pancreatitis; Pancreatitis, Acute Necrotizing; Platelet Activating Factor; Randomized Controlled Trials as Topic; Serine Proteinase Inhibitors; Sphincterotomy, Endoscopic; Thienamycins

Acute calculous cholecystitis is a prevalent disease whose diagnosis and management still face significant debate. Although the overall incidence of gallstone disease is 18.8% in European women aged 30 to 69 years, there is little data and experience in managing acute calculous cholecystitis in populations over 80 years old. The incidence of acute cholecystitis among the elderly is probably increasing. For the reason, we here highlight the advantages and disadvantage of various treatment and management opens based on a 96-year-old patient.. We present a rare case in which a 96-year-old woman suffered from abdominal pain, nausea, and lack of appetite for over a month.. She was diagnosed with acute calculous cholecystitis and pancreatitis.. She was successfully treated without surgery, regaining her physical health after 5 months.. The question of how to manage acute calculous cholecystitis is extremely difficult in many aspects. The patient of very advanced age presented in this paper, not very well diagnosed and with a life-threating condition, survived because of careful treatment and reasonable decision-making.. The take-away from this case is that, in a high-risk senile patient, strict conservative therapy of cholecystitis may be successful, as it can avoid the complications of surgery and leave the patient with a good quality of life.

Topics: Administration, Intravenous; Aged, 80 and over; Anti-Bacterial Agents; Cholecystitis, Acute; Clinical Decision-Making; Conservative Treatment; Data Accuracy; Female; Humans; Meropenem; Pancreatitis; Thienamycins; Treatment Outcome

This study examined the penetration of meropenem into pancreatic juice in patients who had undergone hepato-biliary-pancreatic surgery. The patients received a 0.5-h infusion of 500 mg meropenem. The observed maximum concentration (mean ± standard deviation, n = 5) was 39.1 ± 11.2 μg/ml at 0.5 h in plasma and 2.12 ± 0.73 μg/ml at 1.10 ± 0.14 h in pancreatic juice. The pancreatic juice/plasma ratio was 0.06 ± 0.02. The area under the drug concentration-time curve was 73.0 ± 37.5 μg•h/ml in plasma and 4.24 ± 2.77 μg•h/ml in pancreatic juice. The pancreatic juice/plasma ratio was 0.06 ± 0.01. The mean drug-exposure times above 0.125 μg/ml and 0.25 μg/ml (the minimum inhibitory concentrations (MIC) for common pathogens) in pancreatic juice were 99.4% and 87.3%, respectively, for 500 mg meropenem 3 times daily. This commonly used regimen for pancreatitis achieved the drug-exposure time target (40% of the time above the MIC) at the action site, despite the low penetrability of meropenem.

Topics: Aged; Anti-Bacterial Agents; Biliary Tract Surgical Procedures; Female; Humans; Male; Meropenem; Middle Aged; Pancreatic Juice; Pancreatitis; Thienamycins

This work sought to define how pancreatitis affected antibiotic distribution in a perfused rat pancreas model. The distribution kinetics of four antibiotics were examined in control animals and animals with pancreatitis. Meropenem and piperacillin distributed into the extracellular space, and their distribution kinetics were unaffected by pancreatitis. In contrast, in pancreatic cells from animals with pancreatitis, ciprofloxacin showed a reduced uptake and clindamycin showed a reduced distribution.

Topics: Animals; Anti-Bacterial Agents; Ciprofloxacin; Clindamycin; Male; Meropenem; Organotin Compounds; Pancreatitis; Piperacillin; Rats; Rats, Wistar; Thienamycins

Topics: Acute Disease; Anti-Bacterial Agents; C-Reactive Protein; Humans; Imipenem; Meropenem; Necrosis; Pancreatitis; Thienamycins

Results of surgical treatment of 142 patients with acute destructive pancreatitis were analyzed. The treatment of patients was divided into two periods. The first period included 59 (41.5%) patients when active surgical strategy was used. The second period of observations included 83 (53.5%) patients with the optimized strategy of treatment based on intensive therapy, prognosis of the course of the disease, new antibacterial medicines and new technologies of operative treatment. A comparison of the results of treatment has revealed the advantages of using the optimized strategy and allowed the postoperative lethality to be reduced from 59.3 to 32.5%.

Topics: Acute Disease; Anti-Bacterial Agents; Cephalosporins; Fluoroquinolones; Gastrointestinal Agents; Humans; Meropenem; Octreotide; Pancreatectomy; Pancreatitis; Postoperative Complications; Preoperative Care; Prognosis; Risk Factors; Thienamycins; Time Factors; Ultrasonography

Secondary infection of the inflamed pancreas is the principal cause of death after severe acute pancreatitis (AP). Although patients are not always managed early in the course of AP in clinical practice, prophylactic antibiotics that were used in experimental studies in rats were always initiated early after induction of pancreatitis. The effectiveness of antibiotics initiated later is unknown.. The aim of this study was to compare the effectiveness of ciprofloxacin and meropenem initiated early versus later in the course of acute necrotizing pancreatitis (ANP) in rats.. 100 Sprague-Dawley rats were studied. ANP was induced in rats by intraductal injection of 3% taurocholate. Rats were divided randomly into five groups: group I rats received normal saline as a placebo, group II and IV rats received three times daily meropenem 60 mg/kg i.p. at 2 and 24 h, respectively and group III and V rats received twice daily ciprofloxacin 50 mg/kg i.p. at 2 and 24 h, respectively, after induction. At 96 h, all rats were killed for quantitative bacteriologic study. A point-scoring system of histological features was used to evaluate the severity of pancreatitis.. Meropenem and ciprofloxacin initiated 2 h after induction of pancreatitis significantly reduced the prevalence of pancreatic infection (p < 0.001 and p < 0.04, respectively) as compared to controls. Neither of the antibiotics initiated later during the course of AP caused a significant decrease in pancreatic infection in rats (p > 0.05). Although the rats treated early infected less frequently than the rats treated later, the comparison reached statistical significance only in the meropenem group (p < 0.02).. Early antibiotic treatment reduces pancreatic infection more efficiently than late antibiotic treatment in ANP in rats.

Topics: Animals; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacterial Infections; Ciprofloxacin; Drug Administration Schedule; Male; Meropenem; Pancreatitis; Pancreatitis, Acute Necrotizing; Random Allocation; Rats; Rats, Sprague-Dawley; Thienamycins