Antibiotics Secretion into Pancreatic Fluid

  • N. Martini
  • S. Vesentini
  • C. Bassi
  • M. Falconi
  • R. Girelli
  • A. Messori
  • P. Pederzoli


The development of infective complications in patients with acute pancreatitits and pancreatic fistula is an unfavorable prognistic factor [1–4]. These complications are frequent (from 1 % [4] to 29 % [ 1]) and imply a high rate of morbidity and mortality [2–4]. The therapeutic management of such infections has been the subject of previous reviews [5–7]; however, the problem of the selection of appropriate antimicrobial agents in acute pancreatitis and its complications has not recently been addressed specifically, although new antibiotics have been introduced which are potentially useful for this indication. The present article summarizes the pharmacokinetic data on the penetration of antibiotics in pancreatic tissue and reviews the current information on the bacterial strains involved in this disease.


Acute Pancreatitis Acute Pancreatits Pancreatic Fistula Pancreatic Tissue Pancreatic Juice 
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  1. 1.
    Kodesch R, DuPont HL (1973) Infectious complications of acute pancreatitis. Surg Gynecol Obstet 131:763–767Google Scholar
  2. 2.
    Ranson JHC, Spencer FC (1977) Prevention, diagnosis and treatment of pancreatic abscess. Surgery 82:99–106PubMedGoogle Scholar
  3. 3.
    Beger HG, Buechler M, Bittner R (1988) Necrosectomy and postoperative local lavage in necrotizing pancreatitis. Br J Surg 75:207–212PubMedCrossRefGoogle Scholar
  4. 4.
    Silva J (1985) Antibiotic treatment of complicating infections. In: Davis conference -acute pancreatitis. Ann Int Med 103:86–100PubMedGoogle Scholar
  5. 5.
    Cameron JL, Howes R, Zuidema D (1975) Antibiotic therapy in acute pancreatitis. Surg Clin North Am 55:1319–1325PubMedGoogle Scholar
  6. 6.
    Creutzfeld W, Lankisch P (1981) Intensive medical treatment of severe acute pancreatitis. World J Surg 5:341–350CrossRefGoogle Scholar
  7. 7.
    Lankish PG (1984) Acute and chronic pancreatitits -an update on management. Drugs 28:554–564CrossRefGoogle Scholar
  8. 8.
    Finch WT, Sawyers JL, Schenker S (1976) A prospective study to determine the efficacy of antibiotics in acute pancreatitis. Am Surg 152:670–671Google Scholar
  9. 9.
    Craig RM, Dordal E, Myles L (1975) The use of ampicillin in acute pancreatitis. Ann Int Med 83:831–832PubMedGoogle Scholar
  10. 10.
    Howes R, Zuidema GD, Cameron JL (1975) Evaluation of prophylactic antibiotics in acute pancreatitis. J Surg Res 18:197–200PubMedCrossRefGoogle Scholar
  11. 11.
    Roberts EA, Williams RJ (1979) Ampicillin concentrations in pancreatic fluid bile obtained at endoscopic retrograde cholangiopancreatography (ERCP). Scand J Gastroenterol 14:669–672PubMedCrossRefGoogle Scholar
  12. 12.
    Burch JM (1988) Acute pancreatitis. In: Rakel RE (ed) Conn’s current therapy. Saunders, Philadelphia, pp 438–442Google Scholar
  13. 13.
    Beger HG, Block S, Bittner R (1987) The significance of bacterial infection in acute pancreatitis. In: Beger HG, Buechler M (eds) Acute pancreatitis. Springer, Berlin Heidelberg New York, pp 79–83Google Scholar
  14. 14.
    Beger HG, Bittner R, Block S, Buechler M (1986) Bacterial contamination of pancreatic necrosis -a prospective clinical study. Gastroenterology 91:433–438PubMedGoogle Scholar
  15. 15.
    Kaushik SP, Vohra R, Verma GR, Kaushik S, Sabharwal A (1984) Pancreatic abscess: a review of 17 cases. Br J Surg 71:141–143PubMedCrossRefGoogle Scholar
  16. 16.
    Holden JL, Berne TV, Rosoff L (1976) Pancreatic abscess following acute pancreatitis. Arch Surg 111:858–861PubMedCrossRefGoogle Scholar
  17. 17.
    Donhahue PE, Nyhus LM, Baker RJ (1980) Pancreatic abscess after alcoholic pancreatitis. Arch Surg 115:905–909CrossRefGoogle Scholar
  18. 18.
    Grace SG, State D (1976) Septic complications of pancreatitis. Br J Surg 63:229–232PubMedCrossRefGoogle Scholar
  19. 19.
    Stone HH, Strom PR, Mullins RJ (1984) Pancreatic abscess management by subtotal resection and packing. World J Surg 8:340–345PubMedCrossRefGoogle Scholar
  20. 20.
    Meyer B, Metzger U, Muller F, Siegen Thaler W, Luthy R (1986) Successful treatment of a pancreatic Nocardia asteroides abscess with amikacin and surgical drainage. Antimicrob Agents Chemother 72:150–151Google Scholar
  21. 21.
    Trudel JL, Thompson AG, Brown RA (1984) Prophylactic use of antibiotics in pancreatic sepsis: a 25-year reappraisal. Can J Surg 27:567–570PubMedGoogle Scholar
  22. 22.
    Bassi C, Falconi M, Girelli R (1989) Microbiologial findings in severe pancreatitis. Surg Res Commun 5:1–4Google Scholar
  23. 23.
    Freeny FC; Lewis GP, Traverso LM (1988) Infected pancreatic fluid collection: percutaneous catheter drainage. Radiology 167:435–441PubMedGoogle Scholar
  24. 24.
    Bassi C, Pederzoli P, Falconi M (1987) Microbiological findings in external pancreatic fistulas (abstract). 21st annual meeting of the Pancreas Club. Chicago, abstract 14Google Scholar
  25. 25.
    Pederzoli P, Pilon T, Bassi C (1981) Pancreatic abscess. In: Scuro LA, Dagradi A (eds) Topics in acute and chronic pancreatitis. Springer, Berlin Heidelberg New York, pp 133–135CrossRefGoogle Scholar
  26. 26.
    Hurley JE, Vargish T (1987) Early diagnosis and outcome of pancreatic abscess in pancreatitis. Am Surg 53:29–33PubMedGoogle Scholar
  27. 27.
    Jordan J (1987) Pancreatic fistula. In: Jordan J, Reber H (eds) Surgical disease of the pancreas. Lea and Febiger, Philadelphia, pp 898–901Google Scholar
  28. 28.
    Zinner MJ, Baker RR; Cameron JL (1974) Pancreatic cutaneous fistula. Surg Gynecol Obstet 138:710–712PubMedGoogle Scholar
  29. 29.
    Rubinstein E, Mark Z, Haspel L et al. (1985) Antibacterial activity of the pancreatic fluid. Gastroenterology 88:927–932PubMedGoogle Scholar
  30. 30.
    Pederzoli P, Bassi C, Falconi M (1990) Retroperitoneal and peritoneal drainage-lavage in the treatment of necrotizing pancreatitis: 11 years of experience. Surg Gynecol Obstet 170:197–203PubMedGoogle Scholar
  31. 31.
    Pederzoli P, Bassi C, Falconi M (1986) Conservative treatment of external pancreatic fistula with parenteral nutrition alone or in combination of continuous infusion of somatostatin, glucagon or calcitonin. Surg Gynecol Obstet 163:428–429PubMedGoogle Scholar
  32. 32.
    Wallace R, Cushing RD, Bawdon RE, Sugawa C, Lucas CE, Ledgerwood AM (1986) Assessment of antimicrobial penetrance into the pancreatic juice in humans. Surg Gynecol Obstet 162:313–316PubMedGoogle Scholar
  33. 33.
    Ritzerfeld W, Wittrin G, Gerling W (1982) Mezlocillin concentration in pancreatic tissue and serum after intravenous administration. Proceedings of the 12th international congress of chemotherapy, vol 1. Florence, 1981, pp 649–651Google Scholar
  34. 34.
    Pederzoli P, Ortcalli F, Falconi M, Bozzini L, Martini N (1986) Penetration of mezlocillin into pancreatic juice. J Antimicrob Chemother 17:397–398PubMedCrossRefGoogle Scholar
  35. 35.
    Brattstrom C, Tyden G, Malmborg AS, Lundgren G, Ost L, Groth CG (1987) Studies of the exocrine secretion of segmental pancreatic grafts with special reference to the diagnosis of rejection and to the penetration of drugs into the pancreatic juice. Transplant Proc 19:2332–2335PubMedGoogle Scholar
  36. 36.
    Gregg JA, Mather J, DeGirolami P, Gregg JA (1985) Secretion of beta-lactam antibiotics in pure human pancreatic juice. Am J Surg 150:333–335PubMedCrossRefGoogle Scholar
  37. 37.
    Tyden G, Malmorg AS (1985) Penetration of antibiotics into pancreatic juice. Lancet 1:1046–1047PubMedCrossRefGoogle Scholar
  38. 38.
    Wallace JR, Johnson J, Lucas CE, Cushing R, Ledgerwood AM, Sugawa C (1985) Assessment of pancreatic ductal penetration of antibiotics. 50:666–667Google Scholar
  39. 39.
    Lankisch PG, Klesel N, Seeger K, Seidel G, Winckler K (1985) Penetration of cefotaxime into the pacreas. Z Gastroenterol 1:601–603Google Scholar
  40. 40.
    Yamada Y, Ikehata Y, Matsuda K, Iwamoto M, Fukami H, Sumiyama M (1985) Evaluation of ceftazidime: its clinical effects on surgical infections and its concentration in bile and pancreatic juice. Chemotherapy 31 [Suppl S3]:709–710Google Scholar
  41. 41.
    Pederzoli P, Falconi M, Martini N, Cavallini G, Bassi C, Orcalli F (1985) Rifampicin and ceftazidime concentrations in pure pancreatic juice (abstract). Digestion 32:211–212Google Scholar
  42. 42.
    Preston FW, Silverman M, Henegar GC, Neveril E (1960) The excretion of kanamycin in bile and pancreatic juice. (Proceedings of the 15th international congress of chemotherapy) Antibiot Ann 7 (42): 857–861Google Scholar
  43. 43.
    Pederzoli P, Falconi M, Bassi C et al. (1987) Ciprofloxacin penetration in pancreatic juice. Chemotherapy 33:397–401PubMedCrossRefGoogle Scholar
  44. 44.
    Pederzoli P, Falconi M, Bassi C et al. (1989) Ofloxacin penetration in bile and pancreatic juice. J Antimicrob Chemother 29:805–807CrossRefGoogle Scholar
  45. 45.
    Bertazzoni EM, Pederzoli P, Falconi M, Bassi C, Vesentini S (1987) Pharmacokinetics of metronidazole in patients with pancreatic fistula. Progress in antimicrobial and anticancer chemotherapy. Ecomed, Milano, pp 162–164Google Scholar
  46. 46.
    Benet LZ, Sheiner LB (1985) Design and optimization of dosage regimens: pharmacokinetic data. In: Goodman Gilman A, Goodman LS, Rail TW, Murad F (eds) The pharmacological basis of therapeutics. MacMillan, New York, pp 1663–1733Google Scholar
  47. 47.
    Dainko EA, Paul HA, Gabel A, Beattie EJ (1963) Pancreatic secretion of antibacterial agents through a new pancreatic fistula in the dog. Arch Surg 86:1050–1058PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1992

Authors and Affiliations

  • N. Martini
  • S. Vesentini
  • C. Bassi
  • M. Falconi
  • R. Girelli
  • A. Messori
  • P. Pederzoli

There are no affiliations available

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