Systematic review and meta-analysis of antibiotic prophylaxis in severe acute pancreatitis.
OBJECTIVE
The incidence of acute pancreatitis varies from 5 to 80 per 100,000 throughout the world. The most common cause of death in these patients is infection of pancreatic necrosis by enteric bacteria, spurring the discussion of whether or not prophylactic antibiotic administration could be a beneficial approach. In order to provide evidence of the effect of antibiotic prophylaxis in severe acute pancreatitis (SAP) we performed an updated systematic review and meta-analysis on this topic.


METHODS
The review of randomized controlled trials was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. We conducted a search of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials. For assessment of the treatment effects we calculated the risk ratios (RRs) for dichotomous data of included studies.


RESULTS
Fourteen trials were included with a total of 841 patients. The use of antibiotic prophylaxis was not associated with a statistically significant reduction in mortality (RR 0.74 [95% CI 0.50-1.07]), in the incidence of infected pancreatic necrosis (RR 0.78 [95% CI 0.60-1.02]), in the incidence of non-pancreatic infections (RR 0.70 [95% CI 0.46-1.06]), and in surgical interventions (RR 0.93 [95% CI 0.72-1.20]).


CONCLUSIONS
In summary, to date there is no evidence that supports the routine use of antibiotic prophylaxis in patients with SAP.
Department of General, Visceral and Transplantation Surgery, University Hospital Ulm, Steinhoevelstrasse 9, Ulm, Germany. mathias.wittau@uniklinik-ulm.de
Mathias
M
Wittau
Benjamin
B
Mayer
Jan
J
Scheele
Doris
D
Henne-Bruns
E Patchen
EP
Dellinger
Rainer
R
Isenmann
D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D004756:Enterobacteriaceae Infections / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D016017:Odds Ratio; D010195:Pancreatitis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D019283:Pancreatitis, Acute Necrotizing / Q000453:epidemiology / Q000517:prevention & control
D000900:Anti-Bacterial Agents