Document Detail


The results of severe acute pancreatitis treatment with continuous regional arterial infusion of protease inhibitor and antibiotic: a randomized controlled study.
MedLine Citation:
PMID:  20431422     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: 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.
Authors:
Marta Piaścik; Grazyna Rydzewska; Janusz Milewski; Stanisław Olszewski; Mariusz Furmanek; Jerzy Walecki; Antoni Gabryelewicz
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Pancreas     Volume:  39     ISSN:  1536-4828     ISO Abbreviation:  Pancreas     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-07-28     Completed Date:  2011-02-02     Revised Date:  2011-10-24    
Medline Journal Info:
Nlm Unique ID:  8608542     Medline TA:  Pancreas     Country:  United States    
Other Details:
Languages:  eng     Pagination:  863-7     Citation Subset:  IM    
Affiliation:
Department of Gastroenterology and Internal Medicine, Central Clinical Hospital of Ministry of Home Affairs and Administration, Warsaw, Poland.
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Anti-Bacterial Agents / administration & dosage,  therapeutic use
Drug Administration Schedule
Drug Therapy, Combination
Female
Guanidines / administration & dosage,  therapeutic use*
Humans
Imipenem / administration & dosage,  therapeutic use*
Infusions, Intra-Arterial
Infusions, Intravenous
Male
Middle Aged
Pancreatitis / drug therapy*,  mortality,  pathology
Protease Inhibitors / administration & dosage,  therapeutic use
Severity of Illness Index
Survival Rate
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents; 0/Guanidines; 0/Protease Inhibitors; 74431-23-5/Imipenem; 81525-10-2/nafamostat
Comments/Corrections
Comment In:
Pancreas. 2011 Oct;40(7):1141-2; author reply 1142-3   [PMID:  21926549 ]
Pancreas. 2011 Oct;40(7):1141   [PMID:  21926550 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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