Controlled clinical trial of pefloxacin versus imipenem in severe acute pancreatitis.
OBJECTIVE
Antibiotic prophylaxis in severe pancreatitis has recently yielded promising clinical results, with imipenem significantly reducing the incidence of infected necrosis compared with an untreated control group. On the bases of pefloxacin's spectrum of action and pancreatic penetration, we investigated whether such drugs represent a valid alternative to imipenem.


METHODS
In a multicenter study, 60 patients with severe acute pancreatitis with necrosis affecting at least 50% of the pancreas were randomly allocated to receive intravenous treatment for 2 weeks with pefloxacin, 400 mg twice daily (30 patients), or imipenem, 500 mg three times daily (30 patients), within 120 hours of onset of symptoms. Age, sex, body weight, Ranson and Apache II scores, C-reactive protein, etiology, and time from onset of symptoms to treatment were well matched in the two groups.


RESULTS
The incidences of infected necrosis and extrapancreatic infections were 34% and 44%, respectively, in the pefloxacin group and 10% and 20% in the imipenem group. Imipenem proved significantly more effective in prevention of pancreatic infections (P </= 0.05). Mortality was not significantly different in the two groups.


CONCLUSIONS
Despite its theoretical potential, pefloxacin is inferior to imipenem in the prevention of infections associated with severe pancreatitis.
Bassi
C
C
Surgical, Borgo Roma University Hospital, Verona, Italy.
Falconi
M
M
Talamini
G
G
Uomo
G
G
Papaccio
G
G
Dervenis
C
C
Salvia
R
R
Minelli
E B
EB
Pederzoli
P
P
D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D015378:Imipenem / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000517:prevention & control*; D015366:Pefloxacin / Q000627:therapeutic use*; D012720:Severity of Illness Index; D013845:Thienamycins / Q000627:therapeutic use*
D000890:Anti-Infective Agents; D013845:Thienamycins; D015366:Pefloxacin; D015378:Imipenem