engleski

Imipenem prophylaxis for predicted severe acute pancreatitis - Preliminary results of a randomized clinical trial

Introduction: Infected necrosis is a serious complication of acute pancreatitis leading to a mortality rate of about 40%. Although prophylactic antibiotics are not recommended, meta-analytic data show that imipenem significantly reduces the rate of infected necrosis. Aims: To evaluate the prophylactic use of imipenem in patients with predicted severe acute pancreatitis. Patients & methods: We conducted a single- center, prospective randomized trial. Patients with AP and an APACHE II  8 were randomized to receive either imipenem 500 mg i.v. three times daily for the first ten days or an identical placebo. Exclusion criteria included age < 18 years, any infection present at admission, chronic pancreatitis, active malignancy, immunodeficiency, post-surgical patients, pregnant and breastfeeding women and patients unwilling to participate. Concomitant treatment was similar in both groups. All patients had an abdominal CT scan performed between days 3 to 7, and in cases of clinically suspected infected pancreatic necrosis. Results: Forty- seven consecutive patients were randomized. Twentythree received imipenem and 24 received placebo. Three patients died in the imipenem group, while two patients died in the placebo group (p=0, 667). There were no differences in the occurrence of infected necrosis, with 2 vs. 3 cases, respectively. Other local complications were present in 7 and 13 patients (p¼0, 142), while persistent organ failure was present in 4 and 5 patients (p¼1, 00) in imipenem and placebo group, respectively. Other infection were detected in 2 patients receiving imipenem and 5 patients on placebo (p¼0, 416). Conclusion: Preliminary data showed no significant beneficial effects of prophylactic imipenem in patients with predicted severe acute pancreatitis.

Acute pancreatitis, imipenem, prophylaxis, randomized controlled trial

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