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Systematic review

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Early prophylactic antibiotics administration for acute necrotizing pancreatitis: a meta-analysis of randomized controlled trials.

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Journal Journal of hepato-biliary-pancreatic sciences
Year 2015
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This article is included in 3 Broad syntheses 6 Broad syntheses (3 references)

This article includes 6 Primary studies 6 Primary studies (6 references)

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BACKGROUND: The effectiveness of prophylactic antibiotics use for acute necrotizing pancreatitis has been explored and a number of systematic reviews have been published with conflicting results. The timing of antibiotics administration can be fundamental to their effectiveness, but thus far no reviews have focused on the timing of administration. METHODS: A systematic review of randomized controlled trials (RCTs) of prophylactic antibiotics for acute necrotizing pancreatitis was conducted using MEDLINE (PubMed), CINAHL and Japana Centra Revuo Medicina. Trials in which antibiotics were administered within 72 h after onset of symptoms or 48 h after admission were included. Our primary outcomes were the mortality rate and the incidence of infected pancreatic necrosis, and secondary outcomes were the incidence of non-pancreatic infection and the incidence of surgical intervention. RESULTS: The search revealed six RCTs with a total of 397 patients. The mortality rates were significantly different for those taking antibiotics (7.4%), and controls (14.4%) (odds ratio [OR], 0.48; 95% confidence interval [CI], 0.25-0.94). Also, early prophylactic antibiotics use was associated with reduced incidence of infected pancreatic necrosis (antibiotics 16.3%, controls 25.1%; OR, 0.55; 95% CI, 0.33-0.92). CONCLUSION: Early use of prophylactic antibiotics for acute necrotizing pancreatitis is associated with reduced mortality and lower incidence of infected pancreatic necrosis.

Systematic review

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Role of antibiotic prophylaxis in necrotizing pancreatitis: a meta-analysis.

Journal Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
Year 2015
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This article is included in 3 Broad syntheses 11 Broad syntheses (3 references)

This article includes 11 Primary studies 11 Primary studies (11 references)

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UNLABELLED: Several studies have yielded conflicting results on the role of antibiotic prophylaxis in improving outcomes in acute necrotizing pancreatitis. A meta-analysis was carried out to investigate the impact of antibiotic prophylaxis in the incidence of infected pancreatic necrosis and mortality. METHODOLOGY: Randomized controlled trials and cohort studies investigating impact of prophylactic systemic antibiotic used in acute necrotizing pancreatitis were retrieved from online databases. An overall analysis was done with all studies (Group 1), followed by subgroup analyses with randomized controlled trials (Group 2) and cohort studies (Group 3). Risk ratios (RR) were calculated for the impact of antibiotic prophylaxis in the incidence of infected pancreatic necrosis and mortality in each group using random effects model. RESULTS: Eleven studies involving 864 patients were included. No significant differences in the incidence of infected pancreatic necrosis were observed with prophylactic antibiotic use in all groups. Prophylactic antibiotic use was not associated with significant differences in all-cause mortality in Group 2 (RR = 0.75; p = 0.24) but was associated with a reduction in Groups 1 (RR = 0.66, p = 0.02) and 3 (RR = 0.55, p = 0.04). There was no statistical difference in the incidence of fungal infections and surgical interventions. CONCLUSION: Antibiotic prophylaxis does not significantly reduce the incidence of infected pancreatic necrosis but may affect all-cause mortality in acute necrotizing pancreatitis.

Systematic review

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Present and future of prophylactic antibiotics for severe acute pancreatitis.

Authors Jiang K , Huang W , Yang XN , Xia Q
Journal World journal of gastroenterology : WJG
Year 2012
Links Pubmed DOI PubMed Central

This article is included in 3 Broad syntheses 11 Broad syntheses (3 references)

This article includes 11 Primary studies 11 Primary studies (11 references)

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AIM: To investigate the role of prophylactic antibiotics in the reduction of mortality of severe acute pancreatitis (SAP) patients, which is highly questioned by more and more randomized controlled trials (RCTs) and meta-analyses. METHODS: An updated meta-analysis was performed. RCTs comparing prophylactic antibiotics for SAP with control or placebo were included for meta-analysis. The mortality outcomes were pooled for estimation, and re-pooled estimation was performed by the sensitivity analysis of an ideal large-scale RCT. RESULTS: Currently available 11 RCTs were included. Subgroup analysis showed that there was significant reduction of mortality rate in the period before 2000, while no significant reduction in the period from 2000 [Risk Ratio, (RR) = 1.01, P = 0.98]. Funnel plot indicated that there might be apparent publication bias in the period before 2000. Sensitivity analysis showed that the RR of mortality rate ranged from 0.77 to 1.00 with a relatively narrow confidence interval (P < 0.05). However, the number needed to treat having a minor lower limit of the range (7-5096 patients) implied that certain SAP patients could still potentially prevent death by antibiotic prophylaxis. CONCLUSION: Current evidences do not support prophylactic antibiotics as a routine treatment for SAP, but the potentially benefited sub-population requires further investigations.

Systematic review

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Role of prophylactic antibiotics in the management of acute necrotizing pancreatitis: A meta-analysis.

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Journal 世界华人消化杂志 (World Chinese Journal of Digestology)
Year 2012
Links Google Scholar

This article is included in 2 Broad syntheses 5 Broad syntheses (2 references)

This article includes 5 Primary studies 5 Primary studies (5 references)

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AIM: To evaluate the role of prophylactic antibiotics in the management of acute necrotizing pancreatitis. METHODS: A computerized literature search of Medline, PubMed, Spring, Ovid, Elsevier, Embase, CNKI, and VIP databases was conducted to identify relevant articles published from January 1994 to October 2011. According to the inclusion criteria, 5 studies were selected. The data were analyzed using RevMan 5.1 software. RESULTS: Our meta-analysis suggests that prophylactic antibiotic treatment did not significantly reduce morbility (RR = 0.75, 95%CI 0.43-1.28, P = 0.29) or the incidence of infected pancreatic necrosis (RR = 0.81, 95%CI 0.55-1.19, P = 0.29), nonpancreatic infection (RR = 0.79, 95%CI 0.59-1.06, P = 0.12), or surgical intervention (RR = 0.78, 95%CI 0.45-1.36, P = 0.37). CONCLUSION: Prophylactic antibiotic treatment does not reduce the occurrence of infected pancreatic necrosis, nonpancreatic infection, surgical intervention or morbility in patients with acute necrotizing pancreatitis.

Systematic review

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Systematic review and meta-analysis of antibiotic prophylaxis in severe acute pancreatitis.

Journal Scandinavian journal of gastroenterology
Year 2011
Links Pubmed DOI

This article is included in 1 Structured summary of systematic reviews 14 Structured summaries of systematic reviews (1 reference) 3 Broad syntheses 14 Broad syntheses (3 references)

This article includes 14 Primary studies 14 Primary studies (14 references)

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OBJECTIVE: The incidence of acute pancreatitis varies from 5 to 80 per 100,000 throughout the world. The most common cause of death in these patients is infection of pancreatic necrosis by enteric bacteria, spurring the discussion of whether or not prophylactic antibiotic administration could be a beneficial approach. In order to provide evidence of the effect of antibiotic prophylaxis in severe acute pancreatitis (SAP) we performed an updated systematic review and meta-analysis on this topic. METHODS: The review of randomized controlled trials was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. We conducted a search of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials. For assessment of the treatment effects we calculated the risk ratios (RRs) for dichotomous data of included studies. RESULTS: Fourteen trials were included with a total of 841 patients. The use of antibiotic prophylaxis was not associated with a statistically significant reduction in mortality (RR 0.74 [95% CI 0.50-1.07]), in the incidence of infected pancreatic necrosis (RR 0.78 [95% CI 0.60-1.02]), in the incidence of non-pancreatic infections (RR 0.70 [95% CI 0.46-1.06]), and in surgical interventions (RR 0.93 [95% CI 0.72-1.20]). CONCLUSION: In summary, to date there is no evidence that supports the routine use of antibiotic prophylaxis in patients with SAP.

Systematic review

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Antibiotic therapy for prophylaxis against infection of pancreatic necrosis in acute pancreatitis.

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Authors Villatoro E , Mulla M , Larvin M
Journal Cochrane database of systematic reviews (Online)
Year 2010
Links Pubmed DOI PubMed Central

This article is included in 3 Broad syntheses 7 Broad syntheses (3 references) 1 Structured summary of systematic reviews 7 Structured summaries of systematic reviews (1 reference)

This article includes 7 Primary studies 7 Primary studies (7 references)

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BACKGROUND: Pancreatic necrosis may complicate severe acute pancreatitis, and is detectable by computed tomography (CT). If it becomes infected mortality increases, but the use of prophylactic antibiotics raises concerns about antibiotic resistance and fungal infection. OBJECTIVES: To determine the efficacy and safety of prophylactic antibiotics in acute pancreatitis complicated by CT proven pancreatic necrosis. SEARCH STRATEGY: Searches were updated in November 2008, in The Cochrane Library (Issue 2, 2008), MEDLINE, EMBASE, and CINAHL. Conference proceedings and references from found articles were also searched. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing antibiotics versus placebo in acute pancreatitis with CT proven necrosis. DATA COLLECTION AND ANALYSIS: Primary outcomes were mortality and pancreatic infection rates. Secondary end-points included non pancreatic infection, all sites infection, operative rates, fungal infections, and antibiotic resistance. Subgroup analyses were performed for antibiotic regimen (beta-lactam, quinolone, and imipenem). MAIN RESULTS: Seven evaluable studies randomised 404 patients. There was no statistically significant effect on reduction of mortality with therapy: 8.4% versus controls 14.4%, and infected pancreatic necrosis rates: 19.7% versus controls 24.4%. Non-pancreatic infection rates and the incidence of overall infections were not significantly reduced with antibiotics: 23.7% versus 36%; 37.5% versus 51.9% respectively. Operative treatment and fungal infections were not significantly different. Insufficient data were provided concerning antibiotic resistance.With beta-lactam antibiotic prophylaxis there was less mortality (9.4% treatment, 15% controls), and less infected pancreatic necrosis (16.8% treatment group, 24.2% controls) but this was not statistically significant. The incidence of non-pancreatic infections was non-significantly different (21% versus 32.5%), as was the incidence of overall infections (34.4% versus 52.8%), and operative treatment rates. No significant differences were seen with quinolone plus imidazole in any of the end points measured. Imipenem on its own showed no difference in the incidence of mortality, but there was a significant reduction in the rate of pancreatic infection (p=0.02; RR 0.34, 95% CI 0.13 to 0.84). AUTHORS' CONCLUSIONS: No benefit of antibiotics in preventing infection of pancreatic necrosis or mortality was found, except for when imipenem (a beta-lactam) was considered on its own, where a significantly decrease in pancreatic infection was found. None of the studies included in this review were adequately powered. Further better designed studies are needed if the use of antibiotic prophylaxis is to be recommended.

Systematic review

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Prophylactic antibiotics reduce pancreatic necrosis in acute necrotizing pancreatitis: A meta-analysis of randomized trials

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Authors Yao L , Huang X , Li Y , Shi R , Zhang G
Journal Digestive surgery
Year 2010
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This article is included in 1 Structured summary of systematic reviews 9 Structured summaries of systematic reviews (1 reference) 2 Broad syntheses 9 Broad syntheses (2 references)

This article includes 9 Primary studies 9 Primary studies (9 references)

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Background and Aim: The use of prophylactic antibiotics to prevent infection and reduce mortality in patients with acute necrotizing pancreatitis (ANP) remains controversial. The aim of this study is to perform a systematic review of the data from randomized controlled trials to compare prophylactic antibiotic treatment of patients with ANP versus placebo. Methods: A computerized literature search was conducted using Medline, PubMed, EMBase and Cochrane Central Register of Controlled Trials (CENTRAL) for relevant articles published in English from January 1990 to March 2010. MeSH terms and keywords used to identify articles included 'antibiotic', 'pancreatitis', and 'randomized'. Outcome measures were infected pancreatic necrosis (IPN), mortality, nonpancreatic infection (NPN) and need for surgical intervention. Results: Nine trials involving 564 patients were included. Analysis suggested that IPN was significantly reduced by treatment with antibiotics (RR 0.73, 95% CI 0.54-0.98, p = 0.04). Mortality (p = 0.1), NPN (p = 0.07), and need for surgical intervention (p = 0.17) were not significantly reduced by antibiotic treatment. Subsequent subgroup analysis confirmed that antibiotics were statistically superior to controls in reducing of infected necrosis (p = 0.003) and also mortality (p = 0.02) in single-blinded randomized controlled trials. Conclusion: Prophylactic antibiotic treatment reduced occurrence of IPN, but did not affect mortality, NPN, or surgical intervention in patients with ANP. Copyright © 2010 S. Karger AG, Basel.

Systematic review

Unclassified

Antibiotics prophylaxis in acute necrotizing pancreatitis: an update.

Authors Bai Y , Gao J , Zou DW , Li ZS
Journal The American journal of gastroenterology
Year 2010
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This article is included in 2 Broad syntheses 9 Broad syntheses (2 references)

This article includes 9 Primary studies 9 Primary studies (9 references)

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Systematic review

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Antibiotic prophylaxis is not protective in severe acute pancreatitis: a systematic review and meta-analysis

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Journal American journal of surgery
Year 2009
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This article is included in 1 Structured summary of systematic reviews 8 Structured summaries of systematic reviews (1 reference) 2 Broad syntheses 8 Broad syntheses (2 references)

This article includes 8 Primary studies 8 Primary studies (8 references)

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Background: The use of prophylactic systemic antibiotics to prevent infection and reduce mortality in severe acute pancreatitis (SAP) remains a contentious issue. We assessed the clinical outcome of patients with SAP treated with prophylactic antibiotics compared with that of patients not treated with antibiotics. Methods: We performed a systematic search of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials, using PubMed, Google Scholar, and Ovid as search engines without language restriction until the end of May 2008. We also manually searched the references of original/review articles and evaluated symposia proceedings, poster presentations, and abstracts from major gastrointestinal and surgical meetings. Relative risks were calculated for individual trials and data were pooled using a fixed-effects model. Relative risk (RR) reduction, absolute risk reduction, and number needed to treat were calculated and are reported with 95% confidence intervals. Results: Results were subjected to sensitivity analysis to determine heterogeneity among studies. We pooled 502 patients from 8 studies. Patient age ranged from 43 to 59 years, and length of stay ranged from 18 to 95 days. There were 253 patients with SAP who received prophylactic antibiotics, and 249 patients were randomized to the placebo arm. Overall, there was no protective effect of antibiotic treatment with respect to mortality (RR, .76; 95% confidence interval [CI], .49-1.16). With respect to morbidity, antibiotic prophylaxis did not protect against infected necrosis (RR, .79; 95% CI, .56-1.11) or surgical intervention (RR, .88; 95% CI, .65-1.20). There was, however, an apparent benefit in regards to nonpancreatic infections (RR, .60; 95% CI, .44-.82), with a RR reduction of 40% (95% CI, 18%-56%), absolute risk reduction of 15% (95% CI, 6%-23%), and number needed to treat of 7 (95% CI, 4-17). Conclusions: Antibiotic prophylaxis of SAP does not reduce mortality or protect against infected necrosis, or frequency of surgical intervention. © 2009 Elsevier Inc. All rights reserved.

Systematic review

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Prophylactic antibiotics in necrotizing pancreatitis: A meta-analysis

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Journal Southern medical journal
Year 2008
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This article is included in 1 Structured summary of systematic reviews 7 Structured summaries of systematic reviews (1 reference) 3 Broad syntheses 7 Broad syntheses (3 references)

This article includes 7 Primary studies 7 Primary studies (7 references)

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PURPOSE:: Prophylactic antibiotics have been used in acute necrotizing pancreatitis with mixed results. This meta-analysis analyzes the effects of prophylactic antibiotics in necrotizing pancreatitis. METHODS:: Multiple databases and abstracts were searched for randomized trials comparing treatment with prophylactic antibiotics to treatment without prophylactic antibiotics in necrotizing pancreatitis. Prophylactic antibiotics' effects were analyzed by calculating pooled estimates of mortality, infected pancreatic necrosis, length of hospital stay, nonpancreatic infections, and surgical intervention. RESULTS:: Seven studies (n ≤ 429) met the inclusion criteria. Prophylactic antibiotics for acute necrotizing pancreatitis significantly decreased the length of hospital stay (P ≤ 0.04) and the rate of nonpancreatic infections (P < 0.01). No significant differences were noted for mortality (P ≤ 0.22), infected necrosis (P ≤ 0.18), and surgical intervention (P ≤ 0.40). CONCLUSIONS:: Prophylactic antibiotics in necrotizing pancreatitis reduced the length of hospital stay and rate of nonpancreatic infections but did not decrease mortality, infected necrosis, or surgical intervention. © 2008 by The Southern Medical Association.