Duration of antibiotic treatment after endoscopic ultrasound-guided drainage of walled-off pancreatic necrosis not affecting outcomes

Background and AimAlthough society guidelines recommend a short course of antibiotics after drainage of walled-off necrosis (WON), the exact duration is unclear. MethodsThis is a retrospective review of patients with no prior antibiotic exposure who underwent dual-modality drainage (DMD) for sterile WON from 2008 to 2017. Patients were grouped into short duration (SD, 5days) versus long duration (LD, >5days). The main outcome was the frequency of recurrent infections. ResultsSixty-one patients (25 in the SD group and 36 in the LD group) were included. Patients in the two groups had comparable age, comorbidities, and severity of disease (P=0.89). Patients in the SD group were treated with antibiotics for a median of 3days compared with 8.5days in the LD group. There were no differences in recurrent febrile episodes within 30days of procedure44% of SD group versus 39% of LD (P=0.69). There was also no difference in time to resolution of WON (64days for both groups, P=0.72) or duration of hospitalization post-DMD (SD 7.7days versus LD 7.5days, P=0.42). Three cases of Clostridium difficile colitis were observed in the LD group. ConclusionsLonger course of antibiotics seems to have similar outcomes compared with shorter courses in patients with WON treated with DMD. Prolonged-course therapy may predispose to secondary infections like C.difficile colitis. A randomized controlled trial is needed to evaluate the role and duration of peri-procedural antibiotics after drainage of sterile WON.