Do prophylactic antibiotics improve outcomes in patients with acute necrotizing pancreatitis?

Compared with a control treatment, prophylactic intravenous antibiotics do not significantly improve outcomes in patients with acute necrotizing pancreatitis. The included studies in this meta-analysis, however, were small and of poor quality, so it is likely that there was insufficient power to see important differences. Further studies are needed. (LOE = 1a-)

Mazaki T, Ishii Y, Takayama T. Meta-analysis of prophylactic antibiotic use in acute necrotizing pancreatitis. Br J Surg 2006;93:674-684.  [PMID:16703633]

Meta-analysis (randomized controlled trials)

Unknown/not stated

Inpatient (any location)

These authors systematically reviewed several databases, looking for randomized controlled trials of prophylactic intravenous antibiotics in patients with acute necrotizing pancreatitis. The authors don't report looking for unpublished studies. For studies to be included, the authors required that necrosis be evaluated using contrast-enhanced computed tomography, and infected necrosis be determined by fine-needle aspiration biopsy. Additionally, they required explicit description of the alternate therapies for control patients (not necessarily placebo). Two reviewers independently extracted data with disagreements resolved by discussion. Only 6 trials with 329 patients met all the eligibility criteria. Five of the 6 studies had quality scores of 3 or fewer (out of 5 points). There was no significant difference in the mortality rate in patients receiving antibiotics (10%) and patients receiving a control treatment (17%). Similarly, the authors found no significant difference in the rate of infected necrosis (20% and 29%, respectively). Since the differences in mortality and infection appear clinically important, the available literature only has 46% power. In other words, more study is warranted.