The results of severe acute pancreatitis treatment with continuous regional arterial infusion of protease inhibitor and antibiotic: a randomized controlled study.
OBJECTIVE
A randomized controlled trial was conducted to clarify whether continuous regional arterial infusion (CRAI) of protease inhibitor and antibiotic could reduce mortality rate of severe acute pancreatitis (SAP).


METHODS
Seventy-eight patients with SAP were included in the study. Thirty-nine patients were treated with CRAI, 31 patients completed the study; and another group of 39 patients was treated without CRAI therapy. Groups were well matched in clinical characteristics. The CRAI patients were treated continuously with nafamostat mesylate 240 mg/d and imipenem 1 g/d for 5 days via one of the arteries perfusing the pancreas. Later, imipenem was given intravenously (0.5 g every 8 hours) for 9 days. The non-CRAI patients received imipenem (0.5 g every 8 hours) intravenously for 14 days. Statistical analysis of the intention-to-treat (ITT) group was performed.


RESULTS
Lack of septic complications was observed in 23 patients with CRAI therapy and 20 non-CRAI patients (not significant). The additional antibiotics were applied in 8 of CRAI patients and in 18 non-CRAI (ITT, P = 0.02). Mortality rate was 5.1% in CRAI and 23.1% in non-CRAI group (ITT, P = 0.02). Urgent surgical intervention was necessary in 10.3% CRAI patients and in 33.3% non-CRAI (ITT, P = 0.01).


CONCLUSIONS
The results show that CRAI of protease inhibitor and antibiotic is effective in preventing complications and in reducing mortality rate in SAP.
Piaścik
Marta
M
Department of Gastroenterology and Internal Medicine, Central Clinical Hospital of Ministry of Home Affairs and Administration, Warsaw, Poland.
Rydzewska
Grazyna
G
Milewski
Janusz
J
Olszewski
Stanisław
S
Furmanek
Mariusz
M
Walecki
Jerzy
J
Gabryelewicz
Antoni
A
D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001550:Benzamidines; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006146:Guanidines / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D015378:Imipenem / Q000008:administration & dosage / Q000627:therapeutic use*; D007261:Infusions, Intra-Arterial; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D011480:Protease Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D001550:Benzamidines; D006146:Guanidines; D011480:Protease Inhibitors; D015378:Imipenem; C032855:nafamostat