Prophylaxis with Meropenem of Septic Complications in Acute Pancreatitis: A Randomized, Controlled Trial Versus Imipenem

Objectives Prophylactic antibiotics are helpful in decreasing the incidence of septic complications in acute pancreatitis. The aim of this study was to compare the efficacy of meropenem, a new carbapenem antibiotic, with that of imipenem, which is the standard prophylactic treatment in patients with severe acute pancreatitis. Methods One hundred seventy-six patients with necrotizing pancreatitis were prospectively randomized to prophylactic treatment with 0.5 g meropenem t.i.d. intravenously or 0.5 g imipenem q.i.d. intravenously. The occurrence of infection of pancreatic necrosis, rate of extrapancreatic infections, systemic and local complications, need for surgery, mortality rate, and length of hospitalization were recorded for each group. When a septic complication of pancreatic necrosis was suspected, fine needle aspiration with cultures of the sample was performed. Surgery was performed in cases of verified infected necrosis. Conclusion No difference was observed between patients treated with meropenem and those treated with imipenem in terms of incidence of pancreatic infection (11.4% versus 13.6%) and extrapancreatic infections (21.6% versus 23.9%) and clinical outcome. Meropenem is as effective as imipenem in preventing septic complications of patients with severe acute pancreatitis.

[1]  Ireland,et al.  UK guidelines for the management of acute pancreatitis , 2005, Gut.

[2]  A. Trilla.  Epidemiology of nosocomial infections in adult intensive care units , 1994, Intensive Care Medicine.

[3]  B. Kullberg.  Trends in immunotherapy of fungal infections , 2005, European Journal of Clinical Microbiology and Infectious Diseases.

[4]  W. Bechstein,et al.  [Acute pancreatitis]. , 2004, Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen.

[5]  M. Büchler,et al.  IAP Guidelines for the Surgical Management of Acute Pancreatitis , 2003, Pancreatology.

[6]  M. Büchler,et al.  Cefepime Tissue Penetration in Experimental Acute Pancreatitis , 2003, Pancreas.

[7]  G. Uomo.  Inflammatory Pancreatic Diseases in Older Patients , 2003, Drugs & aging.

[8]  S. Ashley,et al.  Is Severity of Necrotizing Pancreatitis Increased in Extended Necrosis and Infected Necrosis? , 2002, Pancreas.

[9]  G. Bonfiglio,et al.  Recent developments in carbapenems , 2002, Expert opinion on investigational drugs.

[10]  S. L. Triester,et al.  Prognostic factors in acute pancreatitis. , 2002, Journal of clinical gastroenterology.

[11]  E. Organ,et al.  A CUTE N ECROTIZING P ANCREATITIS , 1999 .

[12]  M. Büchler,et al.  Pancreatic infection in severe pancreatitis: the role of fungus and multiresistant organisms. , 2001, Archives of surgery.

[13]  H. Friess,et al.  Acute Necrotizing Pancreatitis: Treatment Strategy According to the Status of Infection , 2000, Annals of surgery.

[14]  G. Uomo,et al.  Pancreatic head mass: how can we treat it? Acute pancreatitis: conservative treatment. , 2000, JOP : Journal of the pancreas.

[15]  A. Siriwardena,et al.  Bacterial infection and extent of necrosis are determinants of organ failure in patients with acute necrotizing pancreatitis , 2000, The British journal of surgery.

[16]  C. Bassi,et al.  Diagnosis, objective assessment of severity, and management of acute pancreatitis , 1999 .

[17]  T. Baron,et al.  Stenotrophomonas (Xanthomonas) maltophilia infection in necrotizing pancreatitis , 1999, International journal of pancreatology : official journal of the International Association of Pancreatology.

[18]  R. Isenmann,et al.  Diagnosis, objective assessment of severity, and management of acute pancreatitis , 1999, International journal of pancreatology : official journal of the International Association of Pancreatology.

[19]  C. Bassi,et al.  Controlled clinical trial of pefloxacin versus imipenem in severe acute pancreatitis. , 1998, Gastroenterology.

[20]  Faizi A. Siddiqi,et al.  Role of antibiotics in acute pancreatitis: A meta-analysis , 1998, Journal of Gastrointestinal Surgery.

[21]  A. Siriwardena,et al.  Antibiotic prophylaxis in the initial management of severe acute pancreatitis , 1998, The British journal of surgery.

[22]  H. Ho,et al.  The role of antibiotic prophylaxis in severe acute pancreatitis. , 1998, Archives of surgery.

[23]  G. Drusano.  Meropenem: laboratory and clinical data. , 1997, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[24]  J. Barkin,et al.  Early antibiotic treatment in acute necrotizing pancreatitis. , 1996, Gastrointestinal endoscopy.

[25]  T. Yzet,et al.  Prophylactic Antibiotics in Treatment of Severe Acute Alcoholic Pancreatitis , 1996, Pancreas.

[26]  S. Matsuno,et al.  Continuous regional arterial infusion of protease inhibitor and antibiotics in acute necrotizing pancreatitis. , 1996, American journal of surgery.

[27]  G. Manes,et al.  Nonsurgical Treatment of Acute Necrotizing Pancreatitis , 1996, Pancreas.

[28]  V. Valtonen,et al.  Early antibiotic treatment in acute necrotising pancreatitis , 1995, The Lancet.

[29]  J. Lange,et al.  Controlled Clinical Trial of Selective Decontamination for the Treatment of Severe Acute Pancreatitis , 1995, Annals of surgery.

[30]  C. Bassi.  Infected pancreatic necrosis , 1994, International journal of pancreatology : official journal of the International Association of Pancreatology.

[31]  A. Benini,et al.  Behavior of antibiotics during human necrotizing pancreatitis , 1994, Antimicrobial Agents and Chemotherapy.

[32]  H. Reber,et al.  Clinically based classification system for acute pancreatitis. , 1993, Pancreas.

[33]  C. Bassi,et al.  A randomized multicenter clinical trial of antibiotic prophylaxis of septic complications in acute necrotizing pancreatitis with imipenem. , 1993, Surgery, gynecology & obstetrics.

[34]  E L Bradley,et al.  A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga, September 11 through 13, 1992. , 1993, Archives of surgery.

[35]  G. Manes,et al.  Relationship between the extent of pancreatic necrosis and sepsis in acute pancreatitis. Results of a prospective study , 1993 .

[36]  Bradley El rd,et al.  A clinically based classification system for acute pancreatitis. , 1993 .

[37]  P. Malfertheiner,et al.  Human pancreatic tissue concentration of bactericidal antibiotics. , 1992, Gastroenterology.

[38]  D L Robinson,et al.  Acute pancreatitis: value of CT in establishing prognosis. , 1990, Radiology.

[39]  G. Tydén,et al.  Penetration of clindamycin, cefoxitin, and piperacillin into pancreatic juice in man. , 1988, Surgery.