title: Present and future of prophylactic antibiotics for severe acute pancreatitis.
abstract: OBJECTIVE
  To investigate the role of prophylactic antibiotics in the reduction of mortality of severe acute pancreatitis (SAP) patients, which is highly questioned by more and more randomized controlled trials (RCTs) and meta-analyses.
  
  
  METHODS
  An updated meta-analysis was performed. RCTs comparing prophylactic antibiotics for SAP with control or placebo were included for meta-analysis. The mortality outcomes were pooled for estimation, and re-pooled estimation was performed by the sensitivity analysis of an ideal large-scale RCT.
  
  
  RESULTS
  Currently available 11 RCTs were included. Subgroup analysis showed that there was significant reduction of mortality rate in the period before 2000, while no significant reduction in the period from 2000 [Risk Ratio, (RR) = 1.01, P = 0.98]. Funnel plot indicated that there might be apparent publication bias in the period before 2000. Sensitivity analysis showed that the RR of mortality rate ranged from 0.77 to 1.00 with a relatively narrow confidence interval (P < 0.05). However, the number needed to treat having a minor lower limit of the range (7-5096 patients) implied that certain SAP patients could still potentially prevent death by antibiotic prophylaxis.
  
  
  CONCLUSIONS
  Current evidences do not support prophylactic antibiotics as a routine treatment for SAP, but the potentially benefited sub-population requires further investigations.
authors.affiliation: Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Kun
authors.initials: K
authors.lastname: Jiang
authors.forename: Wei
authors.initials: W
authors.lastname: Huang
authors.forename: Xiao-Nan
authors.initials: XN
authors.lastname: Yang
authors.forename: Qing
authors.initials: Q
authors.lastname: Xia
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D005544:Forecasting; D006801:Humans; D010195:Pancreatitis / Q000188:drug therapy* / Q000401:mortality; D039781:PubMed; D016032:Randomized Controlled Trials as Topic; D012680:Sensitivity and Specificity
chemical_list: D000900:Anti-Bacterial Agents