• The use of antibiotics in sterile pancreatic necrosis to prevent infection is NOT recommended
• Multiple randomized controlled trials have failed to demonstrate a significant benefit of antibiotics in decreasing mortality or secondary pancreatic infections

Extrapancreatic infections are associated with high morbidity and mortality in patients with acute pancreatitis and should be promptly identified and treated

• Occurs in approximately ⅓ of patients with pancreatic necrosis, and typically presents a week or more into the course of pancreatitis
• Watch for clinical deterioration and start antibiotics as soon as infection is suspected
• Patients with acute pancreatitis often have elevated WBC or fever due to pancreatitis itself, which can be difficult to differentiate from an infection

CT-guided fine needle aspiration is useful in diagnosing infected necrosis and tailoring antibiotics to culture results

Includes:

• Piperacillin-tazobactam
• Cefepime
• Fluoroquinolones
• Metronidazole
• Carbapenems

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9. Bassi C, Pederzoli P, Vesentini S, Falconi M, Bonora A, Abbas H et al. Behavior of antibiotics during human necrotizing pancreatitis. Antimicrob Agents Chemother 1994; 38: 830-6.