Role of Antibiotic Prophylaxis in Necrotizing Pancreatitis: A Meta-Analysis

Lim, Chin Hong; Lee, Winnie; Liew, Yi Xin; Tang, Sarah Si Lin; Chlebicki, Maciej Piotr; Kwa, Andrea Lay-Hoon

doi:10.1007/s11605-014-2662-6

Cited by 65 publications

(37 citation statements)

References 37 publications

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“…Overall, 6 of the 18 studies concluded that prophylactic antibiotics significantly reduced total mortality, which includes 17 RCTs, 18,[20][21][22][23][24] while 4 studies concluded that prophylactic antibiotics significantly reduced the incidence of pancreatic necrosis. 18,20,25,26 The two most recent studies included, 20,21 supported the use of antibiotics. Ukai et al 20 included six RCTs in which antibiotics (within 72 hours) were administered early in patients with acute necrotising pancreatitis, with the exclusion of studies with delayed or indeterminate timing of antibiotic administration.…”

Section: Mortality In Pancreatitis: Are Antibiotics Protective?mentioning

confidence: 99%

“…The study advocates further RCTs to determine the effect of the timing of antibiotic administration on mortality and pancreatic necrosis infection. Lim et al 21 analysed nine RCTs and two cohort studies to determine the benefits of prophylactic antibiotics. The study did not show a significant reduction in the incidence of pancreatic necrosis in the total study population, RCT population or cohort population.…”

Section: Mortality In Pancreatitis: Are Antibiotics Protective?mentioning

confidence: 99%

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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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Section: Mortality In Pancreatitis: Are Antibiotics Protective?mentioning

confidence: 99%

Section: Mortality In Pancreatitis: Are Antibiotics Protective?mentioning

confidence: 99%

Prophylactic antibiotics in acute pancreatitis: endless debate

Mourad

Evans

Kalidindi

et al. 2017

annals

View full text Add to dashboard Cite

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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%

Antibiotic use in acute pancreatitis: An audit of current practice in a tertiary centre

et al. 2016

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“…Encontramos 18 revisiones sistemáticas [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18] que incluyen 19 estudios controlados aleatorizados reportados en 20 artículos, [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38] y dos estudios observacionales [39], [40]. Esta tabla y el resumen en general se basan en los estudios aleatorizados.…”

Section: Acerca Del Conjunto De Evidencia Para Esta Preguntaunclassified

“….5867/medwave.2014.07.6004) debido a la reciente disponibilidad de dos nuevas revisiones sistemáticas, posteriores a la publicación del artículo original [1], [2].…”

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Is antibiotic prophylaxis beneficial in acute pancreatitis: first update

Rada

Peña

2015

Medwave

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This Living FRISBEE (Living FRIendly Summary of the Body of Evidence using Epistemonikos) is an update of the summary published in August 2014, based on two systematic reviews appeared in January and February 2015. There is controversy about the effects of prophylactic antibiotics in acute pancreatitis. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified 18 systematic reviews including 19 randomised studies overall. We combined the evidence using meta-analysis and generated a summary of findings following the GRADE approach. We concluded that prophylactic antibiotics may reduce mortality and length of hospitalization in patients with acute pancreatitis, but the certainty of the evidence is low. The probability that future evidence change what we know is high.

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Role of Antibiotic Prophylaxis in Necrotizing Pancreatitis: A Meta-Analysis

Abstract: Antibiotic prophylaxis does not significantly reduce the incidence of infected pancreatic necrosis but may affect all-cause mortality in acute necrotizing pancreatitis.

Cited by 65 publications

References 37 publications

Prophylactic antibiotics in acute pancreatitis: endless debate

Prophylactic antibiotics in acute pancreatitis: endless debate

Antibiotic use in acute pancreatitis: An audit of current practice in a tertiary centre

Is antibiotic prophylaxis beneficial in acute pancreatitis: first update

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