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Guidelines
Acute Pancreatitis

Acute Pancreatitis

Antibiotic Prophylaxis

  • 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

Antibiotic Treatment Considerations

Infected necrosis 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

Microbiology

Empiric Treatment

Consult Infectious Diseases for antibiotic recommendations

Severe penicillin allergy includes:

  • Anaphylaxis
  • Angioedema
  • Laryngeal edema
  • Severe cutaneous reactions
    • Stevens-Johnson syndrome (SJS) or Toxic Epidermal Necrolysis (TEN)

More Information

  1. Tenner S, Baillie J, et al. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol. 2013;108(9):1400-15.
  2. Working Group IAP/APA Acute Pancreatitis Guideline. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2013;13(4 suppl 2):e1-15.
  3. Solomkin JS, Mazuski JE, et al. Diagnosis and Management of Complicated Intra-abdominal Infection in Adults and Children: Guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis. 2010;50:133-64.
  4. Otto W, Komorzycki K, Krawczyk M. Efficacy of antibiotic penetration into pancreatic necrosis. HPB. 2006;8(1):43-8.
  5. Gloor B, Worni M, Strobel O, et al. Cefepime Tissue Penetration in Experimental Acute Pancreatitis. Pancreas. 2003;26(2):117-21.
  6. Papagoras D, Giamarellos-Bourboulis EJ, Kanara M, et al. Pancreatic concentrations of cefepime in experimental necrotizing pancreatitis. J Chemother. 2003;15(1):43-6.
  7. Saglamkaya U, Mas MR, et al. Penetration of meropenem and cefepime into pancreatic tissue during the course of experimental acute pancreatitis. Pancreas. 2002;24(3):264-8.
  8. Spicak J, Martinek J, et al. Penetation of antibiotics into the pancreas in rats: an effect of acute necrotizing pancreatitis. Scand J Gastroenterol. 1999;34(1):92-7.
  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.