Role of Prophylactic Antibiotic Administration in Severe Acute Pancreatitis: A Meta-Analysis

Abstract

Objective: To carry out a meta-analysis of published studies in order to evaluate the clinical efficacy of prophylactic antibiotics in severe acute pancreatitis (SAP). Material and Methods: MEDLINE, China Biological Medicine, Embase and Cochrane Data Base for Systematic Reviews were searched for randomized controlled trials on the efficacy of prophylactic antibiotics in patients with SAP from 1966 to 2004. Six studies met our inclusion criteria. Two authors (G.S.X. and Z.H.W.) independently extracted the following data from these studies: trial design, characteristics of participants and outcomes. Data were analyzed by Revman 4.2 software. Results: In patients with SAP, prophylactic antibiotics, including broad-spectrum antibiotics that usually achieve therapeutic pancreatic tissue levels, did not reduce pancreatic infection (relative risk, RR, 0.77, 95% confidence interval 0.48–1.24, p = 0.28), surgical intervention (RR 0.84, 95% confidence interval 0.40–1.74, p = 0.64) and mortality rate (RR 0.54, 95% confidence interval 0.28–1.04, p = 0.07). Conclusions: Prophylactic antibiotic administration is not an appropriate treatment strategy in patients with SAP, it should be limited in patients with pancreatic necrosis, as demonstrated by computerized tomography.

Prophylactic antibiotics in acute pancreatitis: endless debate

“…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.…”

Meta-analysis on Surgical Infections

“…Seven of 19 abdominal surgery meta-analyses (36.8%) 5,7,8,[14][15][16]19 focused on acute pancreatitis requiring surgery (six on necrotizing pancreatitis [31.6%] 5,7,8,14,15,19 and one nonnecrotizing [5.3%] 16 ). Five of these seven meta-analyses (26.3%) 5,[14][15][16]19 found no advantage in the use of prophylaxis, whereas two (10.5%) 7,8 found antibiotic prophylaxis to be superior regarding pancreatic infection rates.…”

Acute Pancreatitis: Should We Use Antibiotics?

“…Heinrich et al [35] and Villatoro et al [36] both report mortality benefit but no reduction in infection of pancreatic necrosis with prophylactic antibiotics. Mazaki et al [37] and Xiong et al [38] report no significant benefit in either outcome. All four reviews agree on inclusion of trials by Nordback et al [39] and Isenmann et al [40], the latter marking the first double-blinded study to examine this issue.…”

“…2006 produced an explosion of meta-analysis effort with four publications reaching contradictory results [35][36][37][38]. Heinrich et al [35] and Villatoro et al [36] both report mortality benefit but no reduction in infection of pancreatic necrosis with prophylactic antibiotics.…”