Journal Article

Assessment of prophylactic antibiotics administration for acute pancreatitis: a meta-analysis of randomized controlled trials

Wang, Jian-Hua, Lin, Hai, Chen, Qi-Long, Wen, Li-Mei, Ding, Nan, Yang, Jian-Hua, Sun, Yong-Hui, Cheng, Kun

2020

Overview

Recent evidence has shown that prophylactic antibiotic treatment in patients with acute pancreatitis is not associated with a significant decrease in mortality or morbidity. The use and efficacy of prophylactic antibiotic treatment in acute pancreatitis remain controversial. This meta-analysis was conducted to assess whether antibiotic prophylaxis is beneficial in patients with acute pancreatitis. We searched randomized controlled trials (RCTs) of prophylactic use of antibiotics using Medline (PubMed), Embase, the Cochrane Library, and Web of Science. The data were analyzed using Review Manager 5.3 software. We performed pooled analyses for infected pancreatic necrosis, mortality, surgical intervention, and non-pancreatic infection. Odds ratios (ORs) from each trial were pooled using a random or fixed effects model, depending on the heterogeneity of the included studies. Sub-group analysis or sensitivity analysis was conducted to explore potential sources of heterogeneity, when necessary. Totally, 11 RCTs involving 747 participants were included, with an intervention group (prophylactic use of antibiotics, n = 376) and control group (n = 371). No significant differences were found regarding antibiotic prophylaxis with respect to incidence of infected pancreatic necrosis (OR, 0.74; 95% confidence interval [CI], 0.50-1.09; P = 0.13), surgical intervention (OR, 0.92; 95% CI, 0.62-1.38; P = 0.70), and morality (OR, 0.71; 95% CI, 0.44-1.15; P = 0.16). However, antibiotic prophylaxis was associated with a statistically significant reduction in the incidence of non-pancreatic infection (OR, 0.59; 95% CI, 0.42-0.84; P = 0.004). Prophylactic antibiotics can reduce the incidence of non-pancreatic infection in patients with AP.

• Publisher: Lippincott Williams & Wilkins Ovid Technologies,Department of Pharmacy, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, China%Digestion and Vascular Center, Department of Pancreas Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, China,Wolters Kluwer Health,Wolters Kluwer
• Subject: Acute Disease / Anti-Bacterial Agents - therapeutic use / Antibiotics / Bias / Clinical trials / Collaboration / Confidence intervals / Fungal infections / Humans / Meta Analysis / Mortality / Odds Ratio / Pancreas / Pancreatitis / Pancreatitis - drug therapy / Pneumonia / Randomized Controlled Trials as Topic / Sensitivity analysis / Software / Statistical analysis / Urinary tract infections