Prophylactic antibiotic administration reduces sepsis and mortality in acute necrotizing pancreatitis: A meta-analysis

Severe acute pancreatitis is frequently complicated by local and systemic i nfections resulting in substantial morbidity, mortality, and health care co sts. Antibiotic prophylaxis may prevent some infections. We searched for ra ndomized, controlled trials comparing antibiotic prophylaxis with no prophy laxis in patients with acute necrotizing pancreatitis (ANP). Only trials th at used antibiotics that reach minimum inhibitory concentration (MIC) in ne crotic pancreatic tissue were in eluded. We calculated relative risk reduct ion (RRR), absolute risk reduction (ARR), and number needed to treat (NNT) for individual trials and pooled data. Antibiotic prophylaxis significantly reduced sepsis by 21.1% (NNT = 5) and mortality by 12.3% (NNT = 8) compare d with no prophylaxis. There was also a nonsignificant trend toward a decre ase in local pancreatic infections (ARR = 12%; NNT = 8). Antibiotic prophyl axis decreases sepsis and mortality in patients with ANP. All patients with ANP should be given prophylaxis with an antibiotic with proven efficacy in necrotic pancreatic tissue.