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%1. Although prophylactic antibiotics are not recommended, meta-analytic data show that imipenem significantly reduces the rate of infected necrosis1. Aims & Methods: The aim of our study is to evaluate the prophylactic use of imipenem in patients with predicted severe acute pancreatitis. We conducted a prospective randomized trial in a tertiary care setting in Rijeka. Patients with AP and an APACHE II8 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 age518 years, any infection present at admission, chronic pancreatitis, active malignancy, immunodeficiency, post-surgical patients, pregnant and breastfeeding women and patients unwilling to participate in the study. All patients received early enteral nutrition administered via a nasojejunal tube. 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. Twenty-three 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 (p=0.142), while persistent organ failure was present in 4 and 5 patients (p=1.00) in the imipenem and placebo group, respectively. Other infection were detected in 2 patients receiving imipenem and 5 patients on placebo(p=0.416). Conclusion: Preliminary data showed no significant beneficial effects of prophylactic imipenem use in patients with predicted severe acute pancreatitis.