Clinical Health Updates

Limited evidence on prophylactic antibiotics in acute necrotizing pancreatitis

Clinical Question:
Do prophylactic antibiotics improve outcomes in patients with acute necrotizing pancreatitis?

Bottom Line:
Compared with a control treatment, prophylactic intravenous antibiotics do not significantly improve outcomes in patients with acute necrotizing pancreatitis. The included studies in this meta-analysis, however, were small and of poor quality, so it is likely that there was insufficient power to see important differences. Further studies are needed.

Reference:
Mazaki T, Ishii Y, Takayama T. Meta-analysis of prophylactic antibiotic use in acute necrotizing pancreatitis. Br J Surg 2006;93:674-684.

Study Design:
Meta-analysis (randomized controlled trials)

Synopsis:
Death from infected necrosis in acute pancreatitis is common and prevention has focused on prophylactic antibiotics. This study assesses whether intravenous prophylactic antibiotic use reduces infected necrosis and death in acute necrotizing pancreatitis. A meta-analysis of randomized controlled trials was carried out. Medline, Web of Science, the Cochrane controlled trials register and international conference proceedings were searched, with a citation review of relevant primary and review articles. Six of 328 studies assessed were included in data extraction. Primary outcome measures were infected necrosis and death. Secondary outcome measures were non-pancreatic infections, surgical intervention and length of hospital stay. Prophylactic antibiotic use was not associated with a statistically significant reduction in infected necrosis (relative risk (RR) 0.77 (95 per cent confidence interval (c.i.) 0.54 to 1.12); P = 0.173), mortality (RR 0.78 (95 per cent c.i. 0.44 to 1.39); P = 0.404), non-pancreatic infections (RR 0.71 (95 per cent c.i. 0.32 to 1.58); P = 0.402) and surgical intervention (RR 0.78 (95 per cent c.i. 0.55 to 1.11); P = 0.167). It was, however, associated with a statistically significant reduction in hospital stay (P = 0.040).