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A Clinical Examination of Antibiotics in Continuous Regional Arterial Infusion (CRAI) Therapy for Severe Acute Pancreatitis (SAP)

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  • 重症急性膵炎(SAP)に対する膵局所動注療法の使用抗菌薬に関する検討
  • ─BIPMとIPM/CSの前向き無作為比較試験─
  • -A Prospective Randomized Controlled Trial of BIPM and IPM/CS-

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Abstract

Continuous regional arterial infusion (CRAI) therapy using both protease inhibitors and antibiotics are one of the specific therapeutic methods for severe acute pancreatitis (SAP). As for the administered antibiotics, imipenem/cilastatin sodium (IPM/CS) is generally chosen as a first step, but there are only a few reports comparing IPM/CS with other antibiotics. Therefore, we performed a prospective randomized controlled trial between biapenem (BIPM) and IPM/CS as CRAI antibiotics. Twelve patients with SAP were admitted to our institution during April, 2009 since August, 2006, and were randomized into two groups. They were treated with 120mg/day of nafamostat mesilate and either 1.2g/day of BIPM (n=6) or 2.0g/day of IPM/CS (n=6) for CRAI therapy within 48 hours after the administration. The clinical data, inflammatory markers (WBC, CRP), serum pancreatic enzymes (lipase, tripsin, phospholipase A2, elastase 1 and pancreatic secretory trypsin inhibitor (PSTI) and contrast-enhanced abdominal Computed Tomography findings were compared between the two groups and the adverse effects were monitored. CRAI therapy was performed for seven days. The curative effect of this therapy was evaluated at the beginning of the treatment, the day 7 and the day 14. Our results suggested that BIPM was a non-recessive antibiotic which had an equal effect in CRAI therapy in comparison with IPM/CS.

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