Systematic review and meta-analysis of antibiotic prophylaxis in severe acute pancreatitis

Scand J Gastroenterol. 2011 Mar;46(3):261-70. doi: 10.3109/00365521.2010.531486. Epub 2010 Nov 10.


Objective: The incidence of acute pancreatitis varies from 5 to 80 per 100,000 throughout the world. The most common cause of death in these patients is infection of pancreatic necrosis by enteric bacteria, spurring the discussion of whether or not prophylactic antibiotic administration could be a beneficial approach. In order to provide evidence of the effect of antibiotic prophylaxis in severe acute pancreatitis (SAP) we performed an updated systematic review and meta-analysis on this topic.

Methods: The review of randomized controlled trials was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. We conducted a search of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials. For assessment of the treatment effects we calculated the risk ratios (RRs) for dichotomous data of included studies.

Results: Fourteen trials were included with a total of 841 patients. The use of antibiotic prophylaxis was not associated with a statistically significant reduction in mortality (RR 0.74 [95% CI 0.50-1.07]), in the incidence of infected pancreatic necrosis (RR 0.78 [95% CI 0.60-1.02]), in the incidence of non-pancreatic infections (RR 0.70 [95% CI 0.46-1.06]), and in surgical interventions (RR 0.93 [95% CI 0.72-1.20]).

Conclusion: In summary, to date there is no evidence that supports the routine use of antibiotic prophylaxis in patients with SAP.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Acute Disease
  • Anti-Bacterial Agents / therapeutic use*
  • Antibiotic Prophylaxis*
  • Enterobacteriaceae Infections / epidemiology
  • Enterobacteriaceae Infections / prevention & control
  • Humans
  • Odds Ratio
  • Pancreatitis / drug therapy*
  • Pancreatitis / microbiology
  • Pancreatitis / mortality
  • Pancreatitis, Acute Necrotizing / epidemiology
  • Pancreatitis, Acute Necrotizing / prevention & control


  • Anti-Bacterial Agents