Antibiotic Prophylaxis in Severe Acute Pancreatitis: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

WANG Yanping ¹ ,  LI Debang ² , DONG Chunlu ² , WU Xinan ¹

1. Department of Pharmacy, the First Hospital of Lanzhou University, Lanzhou 730000, China;2. Department of General Surgery, the First Hospital of Lanzhou University, Lanzhou 730000, China;

Corresponding author：

LI Debang, Email: lidebang2011@163.com

Keywords：

Prophylactic antibiotics, Severe acute pancreatitis, Meta-analysis; Systematic review; Randomized controlled trial

DOI：

10.7507/1672-2531.20120074

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Objective 　To systematically assess the efficacy and clinical significance of antibiotic prophylaxis in severe acute pancreatitis (SAP), so as to provide references for its rational clinical application.
Methods 　For collecting the randomized controlled trials (RCTs) about antibiotic prophylaxis in SAP, a search was conducted in MEDLINE, EMbase, Cochrane Central Register of Controlled Trials, CBM and CNKI from the date of their establishment to August, 2010. After the clinical studies meeting the inclusive criteria were extracted and their quality was assessed. Meta-analysis was conduced by using RevMan 5.0 software.
Results 　Twelve RCTs were included with a total of 777 patients. The results of Meta-analysis showed compared with the control group, the antibiotic prophylaxis group was not associated with a statistically signiﬁcant reduction in mortality (RR=0.75, 95%CI 0.50 to 1.12), in the incidence of infected pancreatic necrosis (RR 0.82, 95%CI 0.63 to 1.09), in surgical interventions (RR=0.97, 95%CI 0.74 to 1.26), and in the incidence of nonpancreatic infections (RR=0.73, 95%CI 0.48 to 1.10).
Conclusion 　Antibiotic prophylaxis for SAP does not reduce mortality, infected necrosis, or surgical intervention.

Citation： WANG Yanping,LI Debang,DONG Chunlu,WU Xinan. Antibiotic Prophylaxis in Severe Acute Pancreatitis: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2012, 12(4): 477-483. doi: 10.7507/1672-2531.20120074 Copy

1.	Isenmann R, Rünzi M, Kron M, et al. Prophylactic antibiotic treatment in patients with predicted severe acute pancreatitis a placebo-controlled, double-blind trial. Gastroenterology, 2004, 126(4): 997-1004.
2.	Sainio V, Kemppainen E, Puolakkainen P, et al. Early antibiotic treatment in acute necrotizing pancreatitis. Lancet, 1995, 346(8976): 663-667.
3.	Pederzoli P, Bassi C, Vesentini S. A randomized multicenter clinical trial of antibiotic prophylaxis of septic complications in acute necrotizing pancreatitis with imipenem. Surg Gynecol Obstet, 1993, 176(5): 480-483.
4.	Banks PA, Freeman ML. The Practice Parameters Committee of the American College of Gastroenterology: practiceguidelines in acute pancreatitis. Am J Gastroenterol, 2006, 101(10): 2379-2400.
5.	Garcia-Barrasa A, Borobia F, Pallares R, et al. A double-blind, placebo-controlled trial of ciproﬂoxacin prophylaxis in patients with acute necrotizing pancreatitis. J Gastrointest Surg, 2009, 13(4): 768-774.
6.	Xong GS, Wu SM, Wang ZH. Role of ProPhylactic antibiotic administration in severe acute Pancreatitis: a meta-analysis. Med Princ Pract, 2006, 15(2): 106-110.
7.	Dambrauskas Z, Gulbinas A, Pundzius J, et al. Meta-analysis of ProPhylactic Parenteral antibiotic use in acute necrotizing Panereatitis. Medicina (kaunas), 2007, 43(4): 291-300.
8.	Dellinger EP, Tellado JM, Soto NE, et al. Early antibiotic treatment for severe acute necrotizing pancreatitis: randomized, double-blind placebo-controlled study. Ann Surg, 2007, 245(5): 674-683.
9.	Balthazar EJ, Robinson DL, Megibow AJ, et al. Acute pancreatitis: value of CT in establishing prognosis. Radiology, 1990, 174(2): 331-336.
10.	Moher D, Liberati A, Tetzlaff J. The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA Statement. Open Med, 2009, 3(3): 123-130.
11.	Bradley EL III. A clinically based classiﬁcation system for acute pancreatitis. Summary of the International Symposiumon Acute Pancreatitis. Arch Surg, 1993, 128(5): 586-590.
12.	Toouli J, Brooke-Smith M, Bassi C, et al. Working party of the program committee of the Bangkok World Congress of Gastroenterology. Guideline for the management of acute pancreatitis. J Gastroenterol Hepatol, 2002, 17 suppl: S15-39.
13.	Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions 5.0.2 [updated September 2009]. The Cochrane Collaboration; 2008.
14.	Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst, 1959, 22(4): 719-748.
15.	DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials, 1986, 7(3): 177-188.
16.	Egger M, Davey SG, Schneider M. Bias in meta-analysis detected by a simple, graphical test. BMJ, 1997, 315(7109): 629-634.
17.	Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics, 1994, 50(4): 1088-1101.
18.	Røkke O, Harbitz TB, Liljedal J, et al. Early treatment of severe pancreatitis with imipenem: a prospective randomized clinical trial. Scand JGastroenterol, 2007, 42(6): 771-776.
19.	Yang X, Deng LH, Xue P, et al. Non-preventive use of antibiotics in patients with severe acute pancreatitis treated with integrated traditional Chinese and Western medicine therapy: a randomized controlled trial. J Chin Interg Med, 2009, 7(4): 330-333.
20.	Schwarz M, Isenmann R, Meyer H. Antibiotika bei nekrotisierender Pankreatitis. Ergebnisse einer kontrol lierten Studie. Dtsch Med Wochenschr, 1997, 122(12): 356-361.
21.	Nordback I, Sand J, Saaristo R, et al. Early treatment with antibiotics reduces the need for surgery in acute necrotizing pancreatitis—a single-center randomized study. J Gastrointest Surg, 2001, 5(2): 113-118.
22.	Spicak J, Hubaczova M, Antos F, et al. Antibiotics in the treatment of acute pancreatitis-ﬁndings from a randomized multi-center prospective study. Ces Slov Gastroent Hepatol, 2002, 56(5): 183-193.
23.	Barreda L, Targarono J, Milian W, et al. the prophylactic therapy with imipenem effective for patients with pancreatic necrosis. Acta Gastro enterol Latinoam, 2009, 39(1): 24-29.
24.	Xue P, Deng LH, Zhang ZD, et al. Effect of antibiotic prophylaxis on acutenecrotizing pancreatitis: results of a randomized controlled trial. J Gastroenterol Hepatol, 2009, 24(5): 736-742.
25.	Jafri NS, Mahid SS, Idstein SR, et al. Antibiotic prophylaxis is not preventive in severe acute pancreatitis: a systematic review and meta-analysis. Am J Surg, 2009, 197(6): 806-813.
26.	Spicak J, Hejtmankova S, Hubaczova M, et al. Antibiotic prophylaxis of infectious complications of acute pancreatitis the results of a randomised study by meropenem. Ces Slov Gastroent Hepatol, 2003, 57(6): 222-227.

1. Isenmann R, Rünzi M, Kron M, et al. Prophylactic antibiotic treatment in patients with predicted severe acute pancreatitis a placebo-controlled, double-blind trial. Gastroenterology, 2004, 126(4): 997-1004.
2. Sainio V, Kemppainen E, Puolakkainen P, et al. Early antibiotic treatment in acute necrotizing pancreatitis. Lancet, 1995, 346(8976): 663-667.
3. Pederzoli P, Bassi C, Vesentini S. A randomized multicenter clinical trial of antibiotic prophylaxis of septic complications in acute necrotizing pancreatitis with imipenem. Surg Gynecol Obstet, 1993, 176(5): 480-483.
4. Banks PA, Freeman ML. The Practice Parameters Committee of the American College of Gastroenterology: practiceguidelines in acute pancreatitis. Am J Gastroenterol, 2006, 101(10): 2379-2400.
5. Garcia-Barrasa A, Borobia F, Pallares R, et al. A double-blind, placebo-controlled trial of ciproﬂoxacin prophylaxis in patients with acute necrotizing pancreatitis. J Gastrointest Surg, 2009, 13(4): 768-774.
6. Xong GS, Wu SM, Wang ZH. Role of ProPhylactic antibiotic administration in severe acute Pancreatitis: a meta-analysis. Med Princ Pract, 2006, 15(2): 106-110.
7. Dambrauskas Z, Gulbinas A, Pundzius J, et al. Meta-analysis of ProPhylactic Parenteral antibiotic use in acute necrotizing Panereatitis. Medicina (kaunas), 2007, 43(4): 291-300.
8. Dellinger EP, Tellado JM, Soto NE, et al. Early antibiotic treatment for severe acute necrotizing pancreatitis: randomized, double-blind placebo-controlled study. Ann Surg, 2007, 245(5): 674-683.
9. Balthazar EJ, Robinson DL, Megibow AJ, et al. Acute pancreatitis: value of CT in establishing prognosis. Radiology, 1990, 174(2): 331-336.
10. Moher D, Liberati A, Tetzlaff J. The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA Statement. Open Med, 2009, 3(3): 123-130.
11. Bradley EL III. A clinically based classiﬁcation system for acute pancreatitis. Summary of the International Symposiumon Acute Pancreatitis. Arch Surg, 1993, 128(5): 586-590.
12. Toouli J, Brooke-Smith M, Bassi C, et al. Working party of the program committee of the Bangkok World Congress of Gastroenterology. Guideline for the management of acute pancreatitis. J Gastroenterol Hepatol, 2002, 17 suppl: S15-39.
13. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions 5.0.2 [updated September 2009]. The Cochrane Collaboration; 2008.
14. Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst, 1959, 22(4): 719-748.
15. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials, 1986, 7(3): 177-188.
16. Egger M, Davey SG, Schneider M. Bias in meta-analysis detected by a simple, graphical test. BMJ, 1997, 315(7109): 629-634.
17. Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics, 1994, 50(4): 1088-1101.
18. Røkke O, Harbitz TB, Liljedal J, et al. Early treatment of severe pancreatitis with imipenem: a prospective randomized clinical trial. Scand JGastroenterol, 2007, 42(6): 771-776.
19. Yang X, Deng LH, Xue P, et al. Non-preventive use of antibiotics in patients with severe acute pancreatitis treated with integrated traditional Chinese and Western medicine therapy: a randomized controlled trial. J Chin Interg Med, 2009, 7(4): 330-333.
20. Schwarz M, Isenmann R, Meyer H. Antibiotika bei nekrotisierender Pankreatitis. Ergebnisse einer kontrol lierten Studie. Dtsch Med Wochenschr, 1997, 122(12): 356-361.
21. Nordback I, Sand J, Saaristo R, et al. Early treatment with antibiotics reduces the need for surgery in acute necrotizing pancreatitis—a single-center randomized study. J Gastrointest Surg, 2001, 5(2): 113-118.
22. Spicak J, Hubaczova M, Antos F, et al. Antibiotics in the treatment of acute pancreatitis-ﬁndings from a randomized multi-center prospective study. Ces Slov Gastroent Hepatol, 2002, 56(5): 183-193.
23. Barreda L, Targarono J, Milian W, et al. the prophylactic therapy with imipenem effective for patients with pancreatic necrosis. Acta Gastro enterol Latinoam, 2009, 39(1): 24-29.
24. Xue P, Deng LH, Zhang ZD, et al. Effect of antibiotic prophylaxis on acutenecrotizing pancreatitis: results of a randomized controlled trial. J Gastroenterol Hepatol, 2009, 24(5): 736-742.
25. Jafri NS, Mahid SS, Idstein SR, et al. Antibiotic prophylaxis is not preventive in severe acute pancreatitis: a systematic review and meta-analysis. Am J Surg, 2009, 197(6): 806-813.
26. Spicak J, Hejtmankova S, Hubaczova M, et al. Antibiotic prophylaxis of infectious complications of acute pancreatitis the results of a randomised study by meropenem. Ces Slov Gastroent Hepatol, 2003, 57(6): 222-227.

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