Generally, antibiotics are NOT indicated in patients with severe pancreatitis or who have radiographic evidence of pancreatic necrosis.
Patients with sterile necrosis of the pancreas will often have a profound inflammatory reaction that may mimic sepsis.
Consider extra-pancreatic infections such as cholangitis, catheter associated infections, bacteremia, pneumonia and urinary tract infection.
Infected necrosis should be considered in patients with pancreatic or extra-pancreatic necrosis who deteriorate or fail to improve after 7-10 days of supportive therapy.
In suspected infected pancreatic necrosis, imaging-guided aspiration of pancreatic collection should be used to guide therapy.
Therapy ideally should be based upon culture results, but may also be started empirically if the patient has clear signs of infection and image-guided aspiration cannot be obtained. Strongly recommend Infectious Diseases consultation if therapy is being considered.