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Review
. 2012 Jan 21;18(3):279-84.
doi: 10.3748/wjg.v18.i3.279.

Present and future of prophylactic antibiotics for severe acute pancreatitis

Kun Jiang  1 , Wei Huang, Xiao-Nan Yang, Qing Xia
Affiliations
Review

Present and future of prophylactic antibiotics for severe acute pancreatitis

Kun Jiang et al. World J Gastroenterol. .

Abstract

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.

Keywords: Meta-analysis; Mortality; Prophylactic antibiotics; Severe acute pancreatitis.

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Figures

Figure 1
Figure 1
The flow chart of literature search and selection in PubMed.
Figure 2
Figure 2
Updated meta-analysis of antibiotic prophylaxis vs placebo/none-treatment. The meta-analysis was stratified into two periods, i.e., before 2000 and from 2000. In the later period, no benefit was obtained from prophylactic antibiotics (RR = 1.01, P=0.98; Mantel-Haenszel test, fixed effect model, two-sided).
Figure 3
Figure 3
Funnel plot of the meta-analysis. Apparently asymmetrical distribution was found in the period before 2000.
Figure 4
Figure 4
Linear correlation of accumulated sample size from 2000. There is highly positive correlation between the accumulated sample size and the year from 2000 (r = 0.954, P = 0.000; Pearson correlation test, two-sided).
See this image and copyright information in PMC

References

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