Which is the determining factor for selection of the antimicrobial agent in patient with acute cholangitis, bile or blood ?

aim of our study is a comparison of the efficacy of Mesilate and Urinastatin for PEP prevention Methods: From January 2016 to Aprile 2019, a total of 1797 patients who underwent ERCP were analyzed.Patients received continuous infusion of 500 mL of 5% dextrose solution with 50 mg of nafamostat mesylate (1175 patients) or with 150,000 unit of Urinastatin (622 patients).Serum amylase and lipase levels were checked before ERCP, 4 and 24 hours after ERCP, and when clinically indicated.Patients usually present within a few hours with severe epigastric pain, often radiating to the back, nausea and mild fever with raised pancreatic enzyme levels.Pancreatitis is diagnosed if two of the following three criteria is present; pain consistent with acute pancreatitis, raised serum amylase or lipase levels more than three times normal and (or) typical imaging findings.The incidence of PEP ranges from 3 to 10%.Patient-related risk factors include previous history of PEP, suspected sphincter of Oddi dysfunction, female sex, younger patient age, normal serum bilirubin levels, history of acute recurrent pancreatitis, pregnancy, and cannabis use.Procedure related factors, such as difficult cannulation and large-balloon dilatation of the papilla of an intact biliary sphincter (especially for short duration significantly increase the risk of PEP.Resulsts: There was a significant difference in the incidence of PEP between the Nafamostat mesylate and Urinastatin groups (4.0851% vs 2.0900%, respectively; OR : 0.501295, 95% CI : 0.