[Is the prophylactic antibiotic therapy with Imipenem effective for patients with pancreatic necrosis?].
OBJECTIVE
to evaluate the capacity of Imipenem as a prophylactic treatment for decreasing the number of infected necrosis and surgeries, as well as for diminishing septic complications and the mortality rate among patients with severe acute necrotizing pancreatitis.


METHODS
from May 2005 to December 2007 a prospective randomized study was conducted in order to evaluate the efficacy of a prophylactic antibiotic therapy in patients with pancreatic necrosis. During this time period 58 patients entered the study protocol. Patients were divided in two groups; the first one underwent antibiotic therapy with Imipenem while the second group received no prophylactic treatment at all. All patients received early enteral nutrition.


RESULTS
both studied groups had comparable age, gender ratio, and C.R.P and necrosis percentages. When comparing general morbidity in both groups no difference was found between the group receiving a prophylactic antibiotic and the group that did not receive it (58% vs. 56%). Moreover, when the septic complications were evaluated, it was confirmed that these were more frequent among the group of patients receiving Imipenem (29%), in comparison to the group that did not received antibiotics (15%). 12.5% of the patients that received Imipenem developed pancreatic necrosis infection, while said infection only appeared in 6% of the patients in the group that did not receive antibiotic prophylaxis; nevertheless, none of the comparisons reached statistical significance. The number of patients who required surgery was similar in both groups. When comparing the hospital stay, it was observed that this was longer among the patients receiving prophylactic therapy. No patient died during the study.


CONCLUSIONS
The present study finds no benefits in the use of antibiotic therapy with Imipenem regarding the risk of developing pancreatic necrosis infection and septic complications, and neither when trying to reduce the number of surgeries among patients with severe acute pancreatitis with necrosis.
Barreda
Luis
L
Servicio 6 B Cirugía de Páncreas, Departamento de Cirugía General del Hospital Edgardo Rebagliati Martins, Lima, Perú.
Targarona
Javier
J
Milian
William
W
Portugal
José
J
Sequeiros
Joel
J
Pando
Elizabeth
E
Calisto
Juan Luis
JL
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D015378:Imipenem / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications / Q000188:drug therapy*; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000517:prevention & control*; D055815:Young Adult
D000900:Anti-Bacterial Agents; D015378:Imipenem