Searches were updated in November 2008, in The Cochrane Library (Issue 2, 2008), MEDLINE, EMBASE, and CINAHL. Conference proceedings and references from found articles were also searched.
SELECTION CRITERIA: Seven evaluable studies randomised 404 patients. There was no statistically significant effect on reduction of mortality with
therapy: 8.4% versus controls 14.4%, and infected
pancreatic necrosis rates: 19.7% versus controls 24.4%. Non-pancreatic
infection rates and the incidence of overall
infections were not significantly reduced with
antibiotics: 23.7% versus 36%; 37.5% versus 51.9% respectively. Operative treatment and
fungal infections were not significantly different. Insufficient data were provided concerning antibiotic resistance.With
beta-lactam antibiotic prophylaxis there was less mortality (9.4% treatment, 15% controls), and less infected
pancreatic necrosis (16.8% treatment group, 24.2% controls) but this was not statistically significant. The incidence of non-pancreatic
infections was non-significantly different (21% versus 32.5%), as was the incidence of overall
infections (34.4% versus 52.8%), and operative treatment rates. No significant differences were seen with
quinolone plus
imidazole in any of the end points measured.
Imipenem on its own showed no difference in the incidence of mortality, but there was a significant reduction in the rate of pancreatic
infection (p=0.02; RR 0.34, 95% CI 0.13 to 0.84).
AUTHORS' CONCLUSIONS: