title: Early prophylactic antibiotics administration for acute necrotizing pancreatitis: a meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  The effectiveness of prophylactic antibiotics use for acute necrotizing pancreatitis has been explored and a number of systematic reviews have been published with conflicting results. The timing of antibiotics administration can be fundamental to their effectiveness, but thus far no reviews have focused on the timing of administration.
  
  
  METHODS
  A systematic review of randomized controlled trials (RCTs) of prophylactic antibiotics for acute necrotizing pancreatitis was conducted using MEDLINE (PubMed), CINAHL and Japana Centra Revuo Medicina. Trials in which antibiotics were administered within 72 h after onset of symptoms or 48 h after admission were included. Our primary outcomes were the mortality rate and the incidence of infected pancreatic necrosis, and secondary outcomes were the incidence of non-pancreatic infection and the incidence of surgical intervention.
  
  
  RESULTS
  The search revealed six RCTs with a total of 397 patients. The mortality rates were significantly different for those taking antibiotics (7.4%), and controls (14.4%) (odds ratio [OR], 0.48; 95% confidence interval [CI], 0.25-0.94). Also, early prophylactic antibiotics use was associated with reduced incidence of infected pancreatic necrosis (antibiotics 16.3%, controls 25.1%; OR, 0.55; 95% CI, 0.33-0.92).
  
  
  CONCLUSIONS
  Early use of prophylactic antibiotics for acute necrotizing pancreatitis is associated with reduced mortality and lower incidence of infected pancreatic necrosis.
authors: Department of Community Medicine, Mie University School of Medicine, Tsu, Mie, Japan.
authors: Tomohiko
authors: T
authors: Ukai
authors: Satoru
authors: S
authors: Shikata
authors: Machiko
authors: M
authors: Inoue
authors: Yoshinori
authors: Y
authors: Noguchi
authors: Hisato
authors: H
authors: Igarashi
authors: Shuji
authors: S
authors: Isaji
authors: Toshihiko
authors: T
authors: Mayumi
authors: Masahiro
authors: M
authors: Yoshida
authors: Yousuke C
authors: YC
authors: Takemura
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D006801:Humans; D019283:Pancreatitis, Acute Necrotizing / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotics; Meta-analysis; Pancreatitis