To evaluate the role of prophylactic antibiotic therapy in the prevention of superimposed infection in acute necrotizing pancreatitis, Sharma and Howden conducted a meta-analysis that included the only three randomized, controlled trials published between 1996 and 2000. The selected studies compared supportive treatment plus antibiotic prophylaxis and supportive treatment alone in patients with clinical and radiographic evidence of acute necrotizing pancreatitis. The primary endpoints were occurrence of pancreatic infection, sepsis, and overall mortality. The pooled data consisted of 84 patients in the treatment group and 76 patients in the control group. Absolute and relative risk reduction as well as number needed to treat were calculated for each of the outcomes. Only one of the three trials demonstrated a significant benefit of antibiotic therapy in the prevention of sepsis and death. However, the analysis of the pooled data suggested that sepsis and death were less likely to occur in patients enrolled in the antibiotic arm. The numbers needed to treat to prevent one episode of sepsis and death were five and eight, respectively. Interestingly, the analysis failed to show a significant benefit of prophylactic antibiotics in preventing pancreatic infections. The authors concluded that antibiotics should be given to patients with sterile necrosis because both overall morbidity and mortality can be reduced.