Several studies from the 1970s-2000s showed no benefit of prophylactic antibiotics for acute pancreatitis. However, later trials found antibiotics reduced pancreatic sepsis and mortality rates in patients with necrotizing pancreatitis. A 2011 meta-analysis of 14 trials found no evidence antibiotics reduced infected necrosis, other infections, interventions or mortality overall. However, mortality was lower with antibiotics for certain severe patients. Current guidelines recommend antibiotics only for proven or suspected infected necrosis, not routine prophylaxis. Selection depends on drug penetration to pancreatic tissue.