Prophylactic Antibiotics Cannot Reduce Infected Pancreatic Necrosis and Mortality in Acute Necrotizing Pancreatitis: Evidence From a Meta-Analysis of Randomized Controlled Trials

Bai, Yu; Gao, Jun; Zou, Duowu; Li, Zhao‐Shen

doi:10.1111/j.1572-0241.2007.01575.x

Cited by 138 publications

(79 citation statements)

References 24 publications

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“…Subsequent subgroup analysis confirmed that antibiotics were not significantly superior to placebo or no treatment in reducing the rate of infected necrosis or mortality. 73 A 2012 meta-analysis of 11 RCTs looking at the efficacy of prophylactic antibiotics in acute pancreatitis calculated the number needed to treat to be 1429, 74 and yet another meta-analysis of 14 RCTs (n = 841) showed no statistically significant reduction in mortality (RR 0.74, 95% CI 0.50-1.07), incidence of infected pancreatic necrosis (RR 0.78, 95% CI 0.60-1.02), incidence of nonpancreatic infections (RR 0.70, 95% CI 0.46-1.06), or in surgical interventions (RR 0.93, 95% CI 0.72-1.20). 75 In light of the lack of demonstrated benefit of prophylactic antibiotics in the treatment of acute pancreatitis, the adverse effects of this practice must be carefully considered.…”

Section: Prophylactic Antibioticsmentioning

confidence: 99%

Clinical practice guideline: management of acute pancreatitis

Greenberg¹,

Hsu²,

Bawazeer³

et al. 2016

cjs

324

352

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There has been an increase in the incidence of acute pancreatitis reported worldwide. Despite improvements in access to care, imaging and interventional techniques, acute pancreatitis continues to be associated with significant morbidity and mortality. Despite the availability of clinical practice guidelines for the management of acute pancreatitis, recent studies auditing the clinical management of the condition have shown important areas of noncompliance with evidence-based recommendations. This underscores the importance of creating understandable and implementable recommendations for the diagnosis and management of acute pancreatitis. The purpose of the present guideline is to provide evidence-based recommendations for the management of both mild and severe acute pancreatitis as well as the management of complications of acute pancreatitis and of gall stone-induced pancreatitis.Une hausse de l'incidence de pancréatite aiguë a été constatée à l'échelle mondiale. Malgré l'amélioration de l'accès aux soins et aux techniques d'imagerie et d'intervention, la pancréatite aiguë est toujours associée à une morbidité et une mortalité importantes. Bien qu'il existe des guides de pratique clinique pour la prise en charge de la pancréatite aiguë, des études récentes sur la vérification de la prise en charge clinique de cette affection révèlent des lacunes importantes dans la conformité aux recommandations fondées sur des données probantes. Ces résultats mettent en relief l'importance de formuler des recommandations compréhensibles et applicables pour le diagnostic et la prise en charge de la pancréatite aiguë. La présente ligne directrice vise à fournir des recommandations fondées sur des données probantes pour la prise en charge de la pancréatite aiguë, qu'elle soit bénigne ou grave, ainsi que de ses complications et de celles de la pancréatite causée par un calcul biliaire.A cute pancreatitis can range from a mild, self-limiting disease that requires no more than supportive measures to severe disease with lifethreatening complications. The most common causes of acute pan creatitis are gallstones and binge alcohol consumption.1 There has been an increase in the incidence of acute pancreatitis reported worldwide. Despite improvements in access to care, imaging and interventional techniques, acute pancreatitis continues to be associated with significant morbidity and mortality.A systematic review of clinical practice guidelines for the management of acute pancreatitis revealed 14 guidelines published between 2004 and 2008 alone.2 Although these guidelines have significant overlap in their recommendations for diagnosing and managing acute pancreatitis, there is disagreement in some aspects of both the timing and types of interventions that should be used for both mild and severe acute pancreatitis. The availability of new imaging modalities and noninvasive therapies has also changed clinical practice. Finally, despite the availability of guidelines, recent studies auditing clinical management of acute pancreatitis have sh...

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Section: Prophylactic Antibioticsmentioning

confidence: 99%

Clinical practice guideline: management of acute pancreatitis

Greenberg¹,

Hsu²,

Bawazeer³

et al. 2016

cjs

324

352

View full text Add to dashboard Cite

show abstract

“…As mentioned above, 6 of the 18 studies included in the current review were associated with reduced mortality when prophylactic antibiotics were used and the remaining 12 meta-analyses did not recommend the use of prophylactic antibiotic as there was no significant reduction in mortality with them. [25][26][27][30][31][32][33][34][35][36][37][38] These meta-analyses used a combined total of 14 RCTs with total study population varied from 329 to 841 patients.…”

Section: Mortality In Pancreatitis: Are Antibiotics Protective?mentioning

confidence: 99%

Prophylactic antibiotics in acute pancreatitis: endless debate

Mourad

Evans

Kalidindi

et al. 2017

annals

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INTRODUCTION The development of pancreatic infection is associated with the development of a deteriorating disease with subsequent high morbidity and mortality. There is agreement that in mild pancreatitis there is no need to use antibiotics; in severe pancreatitis it would appear to be a logical choice to use antibiotics to prevent secondary pancreatic infection and decrease associated mortality. MATERIALS AND METHODS A non-systematic review of current evidence, meta-analyses and randomized controlled trials was conducted to assess the role of prophylactic antibiotics in acute pancreatitis and whether it might improve morbidity and mortality in pancreatitis. RESULTS Mixed evidence was found to support and refute the role of prophylactic antibiotics in acute pancreatitis. Most studies have failed to demonstrate much benefit from its routine use. Data from our unit suggested little benefit of their routine use, and showed that the mortality of those treated with antibiotics was significantly higher compared with those not treated with antibiotics (9% vs 0%, respectively, P = 0.043). In addition, the antibiotic group had significantly higher morbidity (36% vs 5%, respectively, P = 0.002). CONCLUSIONS Antibiotics should be used in patients who develop sepsis, infected necrosis-related systemic inflammatory response syndrome, multiple organ dysfunction syndrome or pancreatic and extra-pancreatic infection. Despite the many other factors that should be considered, prompt antibiotic therapy is recommended once inflammatory markers are raised, to prevent secondary pancreatic infection. Unfortunately, there remain many unanswered questions regarding the indications for antibiotic administration and the patients who benefit from antibiotic treatment in acute pancreatitis.

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“…Antibiotic prophylaxis to reduce infective complications in acute pancreatitis was evaluated in a series of randomized trials [4][5][6][7][8][9][10][11][12]. However meta-analyses of these trials do not support antibiotic prophylaxis in acute pancreatitis [13][14][15]. Summarising this evidence, the International Association of Pancreatology/American Pancreatic Association (IAP/APA) produced evidence-based guidelines in 2013 for the management of acute pancreatitis.…”

Section: Introductionmentioning

confidence: 99%