Prophylactic antibiotic treatment for severe acute necrotizing pancreatitis

BACKGROUND AND GOAL OF STUDY:

In patients with severe, necrotizing pancreatitis, it is common to administer prophylactic broad-spectrum antibiotics, as imipenem, to reduce the incidence of pancreatic and peripancreatic infections. The aim of this double-blind, placebo-controlled, randomized study was to evaluate the effectiveness of prophylactic intravenous imipenem in preventing pancreatic and / or peripancreatic infection in patients with non infected necrotizing pancreatitis when compared with placebo.

MATERIALS AND METHODS:

A prospective, double-blind, placebo-controlled randomized study set in ICU of HUC „Mother Theresa“. There were involved 80 patients with clinically severe, confirmed necrotizing pancreatitis in the study: 40 patients received imipenem (750 mg i.v. every 12 hours) and 40 other patients received placebo. Treatment started within 5 days of the onset of symptoms. Treatment continued for 7 days. Patients were followed for 42 days following randomization, focusing in development of complications (infection, the need of surgery and mortality).

RESULTS AND DISCUSSION:

Pancreatic or peripancreatic infections developed in 15% (6 of 40) of patients in the imipenem group compared with 10% (4 of 40) in the placebo group (P = 0.401). Overall mortality rate was 20% (8 of 40) in the imipenem group and 15% (6 of 40) in the placebo group (P = 0.799). Surgical intervention was required in 25% (10 of 40) and 20% (8 of 40) of the imipenem and placebo groups, respectively (P = 0.476). CONCLUSION(S): This study demonstrated no statistically significant difference between the treatment groups for pancreatic or peripancreatic infection, mortality, or requirement for surgical intervention. So, it did not support early prophylactic antimicrobial use in patients with severe acute necrotizing pancreatitis.