title: Early treatment of severe pancreatitis with imipenem: a prospective randomized clinical trial.
abstract: OBJECTIVE
  The main causes of death in severe pancreatitis are multiorgan failure and septic complications. Prophylactic treatment with effective antibiotics is therefore a tempting therapeutic option. However, there could be side effects such as selection of resistant microbes and fungi. The aim of the present study was to compare the rate of infectious complications, interventions, days in the intensive care unit (ICU), morbidity and mortality in patients with severe pancreatitis randomized to prophylactic therapy with imipenem compared with those receiving no treatment at all.
  
  
  METHODS
  Seventy-three patients with severe pancreatitis were included in a prospective, randomized, clinical study in seven Norwegian hospitals. The number of patients was limited to 73 because of slow patient accrual. Severe pancreatitis was defined as a C-reactive protein (CRP) level of >120 mg/l after 24 h or CRP >200 48 h after the start of symptoms. The patients were randomized to either early antibiotic treatment (imipenem 0.5 g x 3 for 5-7 days) (imipenem group) (n=36) or no antibiotics (control group) (n=37).
  
  
  RESULTS
  The groups were similar in age, cause of pancreatitis, duration of symptoms and APACHE II score. Patients in the imipenem group experienced lower rates of complications (12 versus 22 patients) (p=0.035) and infections (5 versus 16 patients) (p=0.009) than those in the control group. There was no difference in length of hospital stay (18 versus 22 days), need of intensive care (8 versus 7 patients), need of acute interventions (10 versus 13), nor for surgery (3 versus 3) or 30-day mortality rates (3 versus 4).
  
  
  CONCLUSIONS
  The study, although underpowered, supports the use of early prophylactic treatment with imipenem in order to reduce the rate of septic complications in patients with severe pancreatitis.
authors.affiliation: Department of Surgery, Haukeland University Hospital, Norway. ola.rokke@ahus.no
authors.forename: Ola
authors.initials: O
authors.lastname: Røkke
authors.forename: Thorstein Bache
authors.initials: TB
authors.lastname: Harbitz
authors.forename: Jermund
authors.initials: J
authors.lastname: Liljedal
authors.forename: Torkel
authors.initials: T
authors.lastname: Pettersen
authors.forename: Torunn
authors.initials: T
authors.lastname: Fetvedt
authors.forename: Leif Øystein
authors.initials: LØ
authors.lastname: Heen
authors.forename: Knut
authors.initials: K
authors.lastname: Skreden
authors.forename: Asgaut
authors.initials: A
authors.lastname: Viste
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D015378:Imipenem / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000188:drug therapy*; D011446:Prospective Studies
chemical_list: D015378:Imipenem