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Antibiotic Therapy

  • Wesley Leung
  • Andres GelrudEmail author
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Abstract

Despite advances in supportive care for patients with acute necrotizing pancreatitis, the majority of patients who die succumb to infectious complications often late (2–4 weeks) in the disease process. Research completed over the past two decades has improved our understanding of infectious complications in patients with acute pancreatitis. Patients with acute necrotizing pancreatitis are at the greatest risk of developing an infection with bacteria translocated from the bowel lumen into the necrotic pancreatic tissue. The most effective antimicrobial agents are the fluoroquinolones and carbapenems, which achieve optimal pancreatic tissue penetration and inhibit the growth of enteric bacteria present in pancreatic infection juice and necrotic tissue. The role of antibiotics in reducing infectious morbidity and mortality has been debated for decades, but current evidence does not support the use of prophylactic antibiotics for the prevention of infection of sterile necrosis. In cases of suspected infected pancreatic necrosis (IPN), antibiotic therapy should be initiated while the source of the infection is being investigated. If no source of infection is identified, antibiotics should be discontinued. Recent evidence suggests a select group of patients with IPN can be managed by antibiotics alone without requiring percutaneous drainage or necrosectomy. However, if these patients deteriorate clinically, more aggressive therapy is warranted.

Keywords

Acute Pancreatitis Clostridium Difficile Infection Pancreatic Tissue Severe Acute Pancreatitis Bacterial Translocation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of Medicine, Section of GastroenterologyCenter for Endoscopic Research and Therapeutics, University of ChicagoChicagoUSA

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