ANTIBIOTICS IN PANCREATITIS: AN OLD ISSUE IN A NEW LIGHT

Harry E. Bray, Charles E. Brady

Research output: Contribution to journalReview articlepeer-review

6 Scopus citations

Abstract

Seventy‐four patients with acute pancreatitis were randomized to receive 500 mg imipenem intravenously every 8 h for 14 days, in addition to supportive medical treatment versus medical treatment alone. Patients were enrolled if they had acute pancreatitis, without clinical evidence of sepsis, and with detectable pancreatic necrosis on CT scanning. The patients were then followed with routine clinical and laboratory parameters to detect the presence of pancreatic sepsis, which was confirmed by guided needle aspiration and culture. A 20.3% overall incidence of pancreatic sepsis was noted: 30.3% of the control group and 12.2% of the antibiotic‐treated group. This difference was significant at P<0.01. Broken down according to the volume of the necrosis as seen on CT, 25% of the control group with mild (less than 30%) necrosis, 36.3% of the control group with moderate (30–50%) necrosis, and 50% of the control group with severe (more than 50%) necrosis developed sepsis. By contrast, 0% of the mild‐ and moderate‐treated groups developed sepsis, as did 35.7% of the treated severe necrosis group. Of note, only two patients in the control group had severe necrosis, compared to 14 in the treatment group, weighting the treatment group toward more serious disease. All five of the septic‐treated group patients underwent surgery, one of whom died; in the untreated arm, two of 10 septic patients who underwent surgery died. Other findings included a significant difference in terms of nonpancreatic sepsis (48.5% control vs 14.6% treated; p<0.01), but the need for surgery and the overall mortality were unaffected by imipenem. The authors concluded that prophylactic imipenem, chosen for its documented penetration into pancreatic tissue, significantly reduces the incidence of pancreatic sepsis in patients with proven pancreatic necrosis.

Original languageEnglish (US)
Pages (from-to)2275-2276
Number of pages2
JournalThe American Journal of Gastroenterology
Volume89
Issue number12
DOIs
StatePublished - Dec 1994

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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