Antibiotic Utilization in Acute Pancreatitis: A Narrative Review

Abstract

Acute pancreatitis is a complex inflammatory disease with significant morbidity and mortality. Despite advances in its management, the role of antibiotics in the prophylaxis and treatment of acute pancreatitis remains controversial. The aim of this comprehensive review is to analyze current evidence on the use of antibiotics in acute pancreatitis, focusing on prophylactic and therapeutic strategies. Prophylactic use aims to prevent local and systemic infections. However, recent studies have questioned the routine use of antibiotics for prophylaxis and highlighted the potential risks of antibiotic resistance and adverse effects. In selected high-risk cases, such as infected necrotizing pancreatitis, prophylactic antibiotic therapy may still be beneficial. As for therapeutic use, antibiotics are usually used to treat infected pancreatic necrosis and extrapancreatic infections. When selecting an antibiotic, the microbiologic profile and local resistance patterns should be considered. Combination therapy with broad-spectrum antibiotics is often recommended to cover both Gram-positive and Gram-negative pathogens. Recent research has highlighted the importance of individualized approaches to antibiotic use in acute pancreatitis and underscored the need for a tailored approach based on patient-specific factors. This review also highlights the potential role of new antimicrobial agents and alternative strategies, such as probiotics, in the management of acute pancreatitis.

Keywords: acute pancreatitis; antibiotics; probiotics; prophylaxis.

Figure 1

Bacterial translocation as a source of infection of pancreatic necrosis. Dysbiosis and intestinal barrier disruption cause intestinal bacteria to invade through the impaired intestinal barrier in a process known as bacterial translocation. This process exacerbates systemic inflammation and causes secondary infection. The abundance of harmful bacteria is significantly higher in AP patients, whereas the abundance of bacteria that produce short-chain fatty acids, which are thought to have anti-inflammatory properties, is significantly lower. PAMPS: Pathogen-associated molecular patterns. ↑: increase in bacterial abundance; ↓ decrease in bacterial abundance. Created with BioRen-der.com.