Pancreatitis, Infected Necrotizing

Pancreatitis, Infected Necrotizing

Guideline Use

Utilize the Severe Sepsis/Septic Shock guidelines

Dose recommendations are based on patients with normal renal function. Refer to dosing in renal impairment

These guidelines may not be appropriate for patients with a history of multi-drug resistant organisms. Consider infectious disease consultation


Antibiotic selection should be guided by cultures where available; empiric choices in this guideline are based on local susceptibilities

  • Signs/Symptoms:
    • ↑ WBC, fever, hypotension common in severe pancreatitis with and without infection
  • Radiographic Imaging:
    • Both infected and non-infected pancreatitis may have walled-off cysts or pseudocysts with peripancreatic or pancreatic necrosis

Consider infected necrotizing pancreatitis if:

  • Fine-needle aspiration and culture reveals organisms
  • Gas evident on imagining
  • 7-10 days of appropriate supportive care with continued deterioration

Management Considerations

Prophylactic antibiotics are not recommended and do not improve outcomes

Yeast, if isolated, should be treated


  • WBC ≤ 12.5
  • Temperature ≤ 38.5ºC
  • No radiographic signs of rupture, abscess, or gas
  • Hospitalized > 48 hours
  • Post-operative

Additional Information

These recommendations are meant to guide empiric therapeutic decision making and are not meant to replace sound clinical decision making. Definitive therapy should be based on culture and susceptibility reports

  • Kyle D. Massey, PharmD

  • Rebekah Gass, MD

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  • Mazuki JE, Tessier JM, May AK, et al. The surgical infection society revised guidelines on the management of intra-abdominal infection. Surgical infections 2017; 18: 1-76. Pubmed
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