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Early treatment of severe pancreatitis with imipenem: a prospective randomized clinical trial

Ola Røkke1, Thorstein Bache Harbitz, Jermund Liljedal

  • 1Department of Surgery, Haukeland University Hospital, Norway. ola.rokke@ahus.no

Scandinavian Journal of Gastroenterology
|May 17, 2007
PubMed
Abstract

Insights

Prophylactic imipenem significantly reduced infectious complications in severe pancreatitis patients. This study suggests early antibiotic use may lower septic risks, despite limitations in patient numbers.

Area of Science:

  • Critical care medicine
  • Infectious diseases
  • Gastroenterology

Background:

  • Severe pancreatitis frequently leads to death from multiorgan failure and septic complications.
  • Prophylactic antibiotics are considered but carry risks like antimicrobial resistance.
  • Effective strategies to prevent infections in severe pancreatitis are crucial.

Purpose of the Study:

  • To compare infectious complications, interventions, ICU stay, morbidity, and mortality.
  • To evaluate prophylactic imipenem versus no antibiotic treatment in severe pancreatitis.
  • To assess the efficacy of early antibiotic prophylaxis in reducing septic complications.

Main Methods:

  • A prospective, randomized clinical study involving 73 patients with severe pancreatitis.
  • Severe pancreatitis defined by C-reactive protein (CRP) levels at 24 and 48 hours.
  • Patients randomized to early imipenem (0.5 g x 3 for 5-7 days) or a control group (no antibiotics).

Main Results:

  • The imipenem group showed significantly lower rates of overall complications (12 vs. 22) and infections (5 vs. 16).
  • No significant differences were observed in hospital stay, ICU admission, acute interventions, surgery, or 30-day mortality.
  • Patient groups were comparable in age, pancreatitis cause, symptom duration, and APACHE II score.

Conclusions:

  • Early prophylactic treatment with imipenem appears to reduce septic complications in severe pancreatitis.
  • The study, though underpowered, supports the use of imipenem for infection prevention.
  • Further research with larger cohorts may be needed to confirm these findings.

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