Severe Pancreatitis

Generally, antibiotics are NOT necessary in patients with 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 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 on culture results, but may also be started empirically if the patient has clear signs of infection and guided aspiration cannot be obtained.