Controlled clinical trial of pefloxacin versus imipenem in severe acute pancreatitis

Background & Aims: Antibiotic prophylaxis in severe pancreatitis has recent ly yielded promising clinical results, with imipenem significantly reducing the incidence of infected necrosis compared with an untreated control grou p. On the bases of pefloxacin's spectrum of action and pancreatic penetrati on, we investigated whether such drugs represent a valid alternative to imi penem, Methods: In a multicenter study, 60 patients with severe acute pancr eatitis 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 pa tients), within 120 hours of onset of symptoms. Age, sex, body weight, Rans on 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 pancr eatic infections (P less than or equal to 0.05), Mortality was not signific antly different in the two groups. Conclusions: Despite its theoretical pot ential, pefloxacin is inferior to imipenem in the prevention of infections associated with severe pancreatitis.