Generally, antibiotics are NOT necessary in patients with pancreatic necrosis.
Prophylactic antibiotics are of no benefit in severe acute pancreatitis, and prophylactic therapy increases the risk of fungal infections and resistant organisms.
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 as causes of fever.
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.