PANCREAS NEWS Antibiotic Prophylaxis in Severe Acute Pancreatitis: Do We Need More Meta-Analytic Studies?

Several guidelines on acute pancreatitis suggest that carbapenems should be used prophylactically and should be continued for 14 days, and that the development of infected necrosis should be assessed using fine-needle aspiration and the sample should be cultured for germ isolation and characterization [1]. In routine clinical practice, antibiotics are used to cure both extrapancreatic infections which appear during the course of acute pancreatitis and infected pancreatic necrosis and also as a prophylaxis in those patients who have pancreatic necrosis in order to prevent possible infection from the necrosis. In the treatment of extrapancreatic infections, the most used antibiotics were cephalosporins whereas carbapenems, glycopeptides and antifungal antibiotics were the most used antibiotics in the treatment of proven infected pancreatic necrosis [2]. Moreover, there are very few topics in pancreatology which cause as much debate as that regarding the utility of antibiotic prophylaxis in severe acute pancreatitis. There are very few human randomized studies and there are more meta-analyses published than studies published. Of course, the cost of a meta-analysis is much less than carrying out a study on the efficacy of antibiotics in severe acute pancreatitis. Thus, I would like to discuss the latest meta-analytic study coming from the United States [3]. In brief, the authors carried out a systematic search of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials, using PubMed, Google Scholar, and Ovid as search engines without language restriction until the end of May 2008. They screened 367 articles of which 55 were found to be relevant to pancreatitis and antibiotics; of these latter 55 articles, only eight met the inclusion criteria: randomized controlled studies; severe acute pancreatitis diagnosed with contrast-enhanced computed tomography and any of the severity criteria such as Acute Physiology An