Less necrosis in acute mesenteric ischemia seen with early use of oral antibiotics

Last Updated: 2019-01-11

By Anne Harding

NEW YORK (Reuters Health) - Oral antibiotics may help prevent intestinal necrosis in patients with acute mesenteric ischemia (AMI), new findings suggest.

"Based on our current knowledge of the disease and our findings, we believe that every AMI patient should receive systematic oral antibiotics upon admission and in addition to early revascularisation," Dr. Alexandre Nuzzo of Beaujon Hospital in Clichy, France, the study's first author, told Reuters Health by email.

Mortality is much higher in AMI patients who develop irreversible transmural intestinal necrosis (ITIN). Revascularization, along with antithrombotics or antibiotics, may be used to prevent or delay ITIN, but "the potential effects of these treatments on intestinal salvage have yet to be evaluated in human clinical practice," Dr. Nuzzo and his colleagues note in the American Journal of Gastroenterology, online December 11.

They looked at 67 AMI patients treated at their center, 34% of whom developed ITIN. Mortality was 13%. Seventy-nine percent received intravenous antibiotics, 55% oral antibiotics and 94% anticoagulants. Among arterial AMI patients, 83% received antiplatelet treatment and 51% underwent revascularization.

Use of oral antibiotics was independently linked to reduced ITIN risk (hazard ratio, 0.16; P=0.01).

Most patients with AMI receive antibiotics, Dr. Nuzzo noted, usually intravenously, but these may be given too late when patients have already developed sepsis.

"Our results suggest that (antibiotics) should be given earlier and systematically to prevent, rather than cure, bacterial translocation," he said.

While morbidity and mortality related to AMI have "dramatically decreased" in patients diagnosed early, the researcher added, "the early recognition of AMI remains a challenge today and many patients are diagnosed too late to allow their bowel and lives to be saved. As a result, the next and even more critical research step will be to improve early recognition of the disease from the emergency room."

SOURCE: https://bit.ly/2SPuGnI

Am J Gastroenterol 2019.