Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jan 21, 2012; 18(3): 279-284
Published online Jan 21, 2012. doi: 10.3748/wjg.v18.i3.279
Present and future of prophylactic antibiotics for severe acute pancreatitis
Kun Jiang, Wei Huang, Xiao-Nan Yang, Qing Xia
Kun Jiang, Xiao-Nan Yang, Qing Xia, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Wei Huang, Liverpool NIHR Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, University of Liverpool, Liverpool L69 3GA, United Kingdom
Author contributions: Jiang K was responsible for the research design, literature search, data extraction, statistics and paper writing; Huang W did the data extraction and language proofreading; Yang XN and Xia Q provided the academic instruction and did proofreading.
Supported by The National Natural Science Foundation of China, No. 81072910
Correspondence to: Qing Xia, Professor, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang Street, Chengdu 610041, Sichuan Province, China. xiaqing@medmail.com.cn
Telephone: +86-28-85423373 Fax: +86-28-85423373
Received: February 22, 2011
Revised: August 12, 2011
Accepted: October 14, 2011
Published online: January 21, 2012
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: Severe acute pancreatitis; Prophylactic antibiotics; Mortality; Meta-analysis