Role of antibiotics in the management of acute pancreatitis

General management of acute pancreatitis is discussed in detail in Acute pancreatitis.

Antibiotic therapy is not recommended for the management of acute pancreatitis except to treat an infected pancreatic fluid collection or acute (ascending) cholangitis.

The use of antibiotics to prevent infection in patients with acute pancreatitis (prophylactic antibiotics) is not recommended. A large meta-analysis assessing prophylactic antibiotics detected no reduction of infection or mortalityWittau, 2011. Furthermore, prolonged antibiotics are associated with intra-abdominal fungal infections.

Note: Prophylactic antibiotics are not recommended for acute pancreatitis.

Severe acute pancreatitis is defined as organ failure that persists for more than 48 hoursBanks, 2013. During a prolonged hospitalisation, patients with severe acute pancreatitis can intermittently appear as though they have sepsis because of the similar presentation of the two conditions; however, this may not necessarily indicate infection. Systemic inflammatory response syndrome (SIRS) is common but, in practice, it is difficult to determine whether this is caused by infection. For the definitions of sepsis and septic shock, see Identifying sepsis or septic shock.

Patients with acute pancreatitis may go on to develop pancreatic fluid collections. Two-thirds of pancreatic fluid collections are sterile and will resolve with conservative management. Following onset of acute pancreatitis, infected pancreatic fluid collections are very rare in the first week, but peak in the second and third week. Antibiotics are not routinely required in the first week after onset of acute pancreatitis. Antibiotics are indicated for acute pancreatitis when either:

  • infection is proven
  • an infected fluid collection is suspected clinically or radiologically, based on observations, biochemistry (C-reactive protein, albumin) or imaging (gas in necrosum).

For more information on severity classification and assessing infective and noninfective causes of acute pancreatitis, see Acute pancreatitis.