A randomized double-blind placebo-controlled trial to evaluate the effect of Rifaximin to reduce the incidence of infected pancreatic Necrosis in patients with Acute necrotizing pancreatitis without persistent organ failure.

Acute pancreatitis is a common inflammatory disease of the pancreas with a significant healthcare burden. While most cases are mild and self-limiting, approximately 10-20% of patients progress to moderately severe or severe AP, which carries a high risk of complications. Overall mortality of AP patients is approximately 5% and can reach up to 20-30% in patients with severe acute pancreatitis and infected necrosis. One of the most concerning complications is infectious complications, occurring in up to 40-70% of patients with acute necrotizing pancreatitis. Rifaximin offers a targeted approach with a favourable safety profile. Rifaximin has emerged as a potential therapeutic option for gut decontamination in various GI disorders. Previous research on rifaximin in acute pancreatitis has been limited. Administration of rifaximin reduces infectious complications and hospital readmission rates in patients with moderately severe and severe acute pancreatitis with peripancreatic collections compared to placebo. This randomized controlled trial is needed to definitively assess efficacy and safety.