Eight randomised controlled trials (RCTs) were included (n=540 patients, range 26 to 114). Two trials were considered of low quality.
There was no evidence that antibiotic prophylaxis reduced mortality (RR 0.76, 95% CI 0.50 to 1.18) or surgical intervention (RR 0.90, 95% CI 0.66 to 1.23) for acute necrotizing pancreatitis. Antibiotic prophylaxis significantly reduced pancreatic or peri-pancreatic infection (RR 0.69, 95% CI 0.50 to 0.95). Antibiotic therapy significantly reduced the length of hospital stay (WMD 5.64 days, 95% CI 0.27 to 11.01), but this result was only based on three trials. There was no evidence of statistical heterogeneity in the outcome assessments.
In the subgroup analysis, carbapenem antibiotics were associated with significant reductions in pancreatic and non-pancreatic infections, but other antibiotics were not.