Randomized controlled trials of antibiotic prophylaxis in severe acute pancreatitis: relationship between methodological quality and outcome.
OBJECTIVE
To evaluate the methodological quality of randomized controlled trials (RCTs) of systemic antibiotic prophylaxis in severe acute pancreatitis in relation to outcome.


METHODS
The MEDLINE, EMBASE and Cochrane databases were searched for RCTs that studied the effectiveness of systemic antibiotic prophylaxis in severe acute pancreatitis. A meta-analysis was performed with a random effects model. Methodological quality was quantified by a previously published scoring system (range 0-17 points).


RESULTS
Six studies, with a total of 397 participants, obtained a methodological score of at least 5 points and were included. Systemic antibiotic prophylaxis had no significant effect on infection of pancreatic necrosis (absolute risk reduction (ARR) 0.055; 95% CI -0.084 to 0.194) and mortality (ARR 0.058, 95% CI -0.017 to 0.134). Spearman correlation showed an inverse association between methodological quality and ARR for mortality (correlation coefficient -0.841, p = 0.036).


CONCLUSIONS
The inverse relationship between methodological quality and impact of antibiotic prophylaxis on mortality emphasizes the importance of high-quality RCTs. At present, adequate evidence for the routine use of antibiotic prophylaxis in severe acute pancreatitis is lacking.
de Vries
Annemarie C
AC
Gastrointestinal Research Unit, Department of Gastroenterology, University Medical Center Utrecht, Utrecht, The Netherlands.
Besselink
Marc G H
MG
Buskens
Erik
E
Ridwan
Ben U
BU
Schipper
Maria
M
van Erpecum
Karel J
KJ
Gooszen
Hein G
HG
D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D006801:Humans; D017053:Infection Control / Q000379:methods; D009336:Necrosis / Q000517:prevention & control; D010179:Pancreas / Q000473:pathology; D010195:Pancreatitis / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic / Q000379:methods*; D040242:Risk Reduction Behavior
D000900:Anti-Bacterial Agents