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Prophylactic Antibiotics Cannot Reduce Infected Pancreatic Necrosis and Mortality in Acute Necrotizing Pancreatitis

Evidence From a Meta-Analysis of Randomized Controlled Trials

Bai, Yu, M.D.; Gao, Jun, M.D.; Zou, Duo-wu, M.D.; Li, Zhao-shen, M.D.

American Journal of Gastroenterology: January 2008 - Volume 103 - Issue 1 - p 104–110

BACKGROUND There is no agreement whether intravenous prophylactic antibiotics can reduce infected pancreatic necrosis and mortality in acute necrotizing pancreatitis (ANP). We performed a meta-analysis comparing intravenous antibiotics with placebo or no treatment in randomized controlled trials (RCTs).

METHODS Databases including MEDLINE, EMBASE, the Cochrane controlled trials register, the Cochrane Library, and Science Citation Index were searched to find relevant trials. Outcome measures were infected necrosis and mortality.

RESULTS Seven trials involving 467 patients were included. Analysis suggested infected pancreatic necrosis rates were not significantly different (antibiotics 17.8%, controls 22.9%), RR 0.81 (95% CI 0.54–1.22). There was nonsignificantly decreased mortality with antibiotics (9.3%) versus controls (15.2%), RR 0.70 (95% CI 0.42–1.17). Subsequent subgroup analysis confirmed antibiotics were not statistically superior to controls in reduction of infected necrosis and mortality.

CONCLUSIONS Prophylactic antibiotics cannot reduce infected pancreatic necrosis and mortality in patients with ANP.

Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China

Reprint requests and correspondence: Zhao-shen Li, M.D, Department of Gastroenterology, Changhai Hospital, Second Military Medical University, 174 Changhai Road, Shanghai, China.

Received June 4, 2007; accepted August 12, 2007.

CONFLICT OF INTERESTGuarantor of the article: Zhao-shen Li, M.D.

Specific author contributions: Yu Bai performed the literature search and the statistical analyses. Jun Gao validated selection of studies and performed part of the statistical analyses. Duo-wu Zou contributed to the editing of the meta-analysis.

Financial support: None.

Potential competing interests: None.

© The American College of Gastroenterology 2008. All Rights Reserved.
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