Meta-analysis of prophylactic antibiotic use in acute necrotizing pancreatitis.
BACKGROUND
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.


METHODS
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.


RESULTS
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).


CONCLUSIONS
Prophylactic antibiotics do not prevent infected necrosis or death in acute necrotizing pancreatitis.
Mazaki
T
T
Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan. tmazaki@med.nihon-u.ac.jp
Ishii
Y
Y
Takayama
T
T
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D001424:Bacterial Infections / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000382:microbiology* / Q000401:mortality; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents