Prophylaxis with meropenem of septic complications in acute pancreatitis: a randomized, controlled trial versus imipenem.
OBJECTIVE
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.


CONCLUSIONS
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.
Manes
Gianpiero
G
Department of Gastroenterology, Cardarelli Hospital, Napoli, Italy.
Rabitti
Pier Giorgio
PG
Menchise
Antonella
A
Riccio
Elisabetta
E
Balzano
Antonio
A
Uomo
Generoso
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001419:Bacteria / Q000187:drug effects / Q000302:isolation & purification; D005260:Female; D006801:Humans; D015378:Imipenem / Q000627:therapeutic use*; D008297:Male; D000077731:Meropenem; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications*; D011446:Prospective Studies; D018805:Sepsis / Q000150:complications / Q000382:microbiology / Q000517:prevention & control*; D013845:Thienamycins / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D013845:Thienamycins; D015378:Imipenem; D000077731:Meropenem