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Are antibiotics useful in treating acute pancreatitis in dogs?

Clinical Scenario

'Daisy', a 6 year old Cavalier King Charles Spaniel presents with suspected pancreatitis; she is vomiting, has diarrhoea without blood and on examination is tense and painful in the cranial abdomen. You start her on supportive and symptomatic treatment while awaiting lab results including Spec cPL to return. Daisy is started on IVFT, analgesia appropriate to the level of pain and micro-entral nutrition but you wonder whether you should also include antibiotics? Daisy's owner is very worried as she has heard that dogs can die from pancreatitis. You ask yourself whether starting Daisy on antibiotics would result in a lower risk of mortality....

3-Part Question (PICO)

In [dogs with acute pancreatitis] does [supportive therapy with antibiotics compared to supportive therapy without antibiotics] lead to a [reduced risk of mortality]?

Search Strategy and Summary of Evidence

Search Strategy

MEDLINE(R) In-Process & Other Non-Indexed Citations and MEDLINE(R) 1946 to Present using the OVID interface

(dog.mp. OR dogs.mp. OR canine.mp. OR canines.mp. OR canis.mp. OR exp Dogs/)

AND

(pancreatitis.mp. OR pancreatic.mp. OR pancreatitic.mp. OR pancreas.mp. OR pancreatic disease.mp. OR pancreatic diseases.mp. OR exocrine pancreatic disease.mp. OR acute pancreatitis.mp. OR pancreatic inflammation.mp. OR exp pancreatitis/ OR exp pancreas/ OR exp pancreatic diseases/)

AND

(antibiotic.mp. OR antibiotics.mp. OR anti-biotic.mp. OR anti-biotics.mp. OR antibacterial.mp. OR antibacterials.mp. OR anti-bacterial.mp. OR anti-bacterials.mp. OR antimicrobial.mp. OR antimicrobials.mp. OR anti-microbial.mp. OR anti-microbials.mp. OR antibiosis.mp. OR antibacterial agents.mp. OR antiinfective agents.mp. OR exp antibiotics/ OR exp antibacterial agents/ OR exp antibiosis/ OR exp antiinfective agents/)

CAB Abstracts 1910 to Present using the OVID interface

(dog.mp. OR dogs.mp. OR canine.mp. OR canines.mp. OR canis.mp. OR exp Dogs/)

AND

(pancreatitis.mp. OR pancreatic.mp. OR pancreatitic.mp. OR pancreas.mp. OR pancreatic disease.mp. OR pancreatic diseases.mp. OR exocrine pancreatic disease.mp. OR acute pancreatitis.mp. OR pancreatic inflammation.mp. OR exp pancreatitis/ OR exp pancreas/ OR exp pancreatic diseases/)

AND

(antibiotic.mp. OR antibiotics.mp. OR anti-biotic.mp. OR anti-biotics.mp. OR antibacterial.mp. OR antibacterials.mp. OR anti-bacterial.mp. OR anti-bacterials.mp. OR antimicrobial.mp. OR antimicrobials.mp. OR anti-microbial.mp. OR anti-microbials.mp. OR antibiosis.mp. OR antibacterial agents.mp. OR antiinfective agents.mp. OR exp antibiotics/ OR exp antibacterial agents/ OR exp antibiosis/ OR exp antiinfective agents/)

Search Outcome

MEDLINE

  • 460 papers found in MEDLINE search
  • 456 papers excluded as they don't meet the PICO question
  • 0 papers excluded as they are in a foreign language
  • 4 papers excluded as they are review articles/in vitro research/conference proceedings
  • 0 total relevant papers from MEDLINE

CAB Abstracts

  • 143 papers found in CAB search
  • 125 papers excluded as they don't meet the PICO question
  • 0 papers excluded as they are in a foreign language
  • 18 papers excluded as they are review articles/in vitro research/conference proceedings
  • 0 total relevant papers from CAB

Total relevant papers

0 relevant papers from both MEDLINE and CAB Abstracts

Comments

No papers have been included in this BET as none of the returned papers fitted the PICO question, were peer-reviewed and non-experimental.

Summary of Evidence

No Summary of Evidence yet.

Comments

Many papers were found that mentioned pancreatitis in dogs and antibiotic use. However, many of them were based on expert opinion or reporting experimentally induced severe acute pancreatitis. 

The current understanding of acute pancreatitis in dogs is that it may not be a single disease, but a manifestation of the impact of a variety of conditions. In a very ill patient there is difficulty in distinguishing severe inflammatory effects from sepsis and so determining if antibiotics are necessary is challenging.

There is a need for further research in the area of antibiotic use in pancreatitis in order to generate evidence regarding clinical outcomes such as mortality. At present the decision to use antibiotics or not in a case of acute canine pancreatitis relies on considering the limitations of the current evidence-base, assessing the benefits and risks to the patient and communicating these to the owner, and clinician experience.

Bottom line

There is currently no peer-reviewed evidence in existance looking at antibiotic use in acute pancreatitis and its effect on mortality.  Therefore, clinical approach should be based on the expertise of the vet, individual practice guidelines where available and the requirements of the patient and owner.

Disclaimer

The BETs on this website are a summary of the evidence found on a topic and are not clinical guidelines. It is the responsibility of the individual veterinary surgeon to ensure appropriate decisions are made based on the specific circumstances of patients under their care, taking into account other factors such as local licensing regulations. Read small print

References

About this BET

First author:
Sarah Keir
Second author:
Marnie Brennan
Institution:

Dave Cumber Vets, Weymouth, Dorset

CEVM, The University of Nottingham

Search last performed:
2018-08-01 09:00:27
Original publication date:
2018-09-30 09:00:27
Last updated:
2018-08-01 09:00:27
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