Bai Y et al. (2008) Prophylactic antibiotics cannot reduce infected pancreatic necrosis and mortality in acute necrotizing pancreatitis: evidence from a meta-analysis of randomized controlled trials. Am J Gastroenterol 103: 104–110

Most patients who present with acute necrotizing pancreatitis (ANP) recover fully within around 1 week, but 20% develop complications that are fatal in 10–30% of cases. Prophylactic antibiotics are commonly used to prevent one major complication—infected pancreatic necrosis—but results from trials designed to demonstrate the effectiveness of this therapy have produced conflicting results.

Bai et al. performed a meta-analysis to evaluate the evidence from randomized, controlled trials and to provide definitive information on the efficacy of antibiotic prophylaxis in ANP. Seven trials involving 467 ANP patients were identified in the MEDLINE and EMBASE databases, the Cochrane controlled trials register, the Cochrane Library, and the Science Citation Index. Data from these studies were analyzed to explore associations between infected pancreatic necrosis, antibiotic use and mortality.

The authors found that the rate at which patients with ANP developed infected pancreatic necrosis was not significantly different between those who were given prophylactic antibiotics and those who were not (17.8% versus 22.9%). Mortality was slightly lower in patients given antibiotics, but the difference between treated and untreated groups was not significant.

The authors conclude that giving patients with ANP prophylactic antibiotics to reduce the risk of infected pancreatic necrosis and to decrease mortality does not seem justified. They recommend, however, that this issue should be clarified in large, well-designed, randomized, placebo-controlled, double-blind trials.