[Antibiotic prophylaxis in acute pancreatitis--is the evidence good enough?]

Randomized controlled trials on acute necrotizing pancreatitis suggest that prophylactic antibiotics can reduce mortality and morbidity in these patients by preventing pancreatic infections.

Relevant articles were assessed using a clinical appraisal skills programme.

Eight trials have been published since 1990. The early trials showed that prophylactic antibiotics did reduce mortality and morbidity; however, errors of methodology weaken these results. In later trials results have varied: in September 2004, Isenmann et al. published a trial with a greatly improved design and found no effect of prophylactic antibiotics compared to antibiotic treatment on demand.

Based on the results obtained so far, the evidence is not yet strong enough to recommend prophylactic antibiotics in acute necrotizing pancreatitis. There is still a need for a new, larger, multicentre study that pays careful attention to all aspects of the condition, for instance diagnosis and treatment of abdominal compartment syndrome, and guidelines for method and time of surgery.