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Semin Respir Crit Care Med 2011; 32(2): 174-180
DOI: 10.1055/s-0031-1275529
© Thieme Medical Publishers

Rational Use of Antimicrobials in Patients with Severe Acute Pancreatitis

Jan J. De Waele1
  • 1Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium
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Publication History

Publication Date:
19 April 2011 (online)

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ABSTRACT

Infectious complications in severe acute pancreatitis are associated with considerable morbidity and mortality. The course of the disease is often protracted, and patients often stay in the hospital for several weeks. Diagnosis of infected pancreatic necrosis is difficult, and the treatment consists of source control and antibiotic treatment. Antibiotic use should be rational in terms of a rational indication, a rational spectrum, and a rational duration. Prophylactic antibiotics are not effective in reducing the incidence of (peri)-pancreatic infection in patients with severe disease (or even documented necrotizing pancreatitis). The only rational indication for antibiotics is documented infection. The spectrum of empirical antibiotics should include both aerobic and anaerobic gram-negative and gram-positive microorganisms. Also, fungal infections are often present in these patients, and antifungal coverage or even prophylaxis should be considered, especially if multiple risk factors for invasive candidiasis are present. Although initiation of antibiotics may be a difficult decision, stopping antibiotic therapy often proves to be even more difficult. Currently, no tools are available to guide antimicrobial treatment. Antibiotic use is only effective if proper source control has been established.

KEYWORDS

Acute pancreatitis - infected pancreatic necrosis - necrotizing pancreatitis - severe acute pancreatitis - walled-off necrosis

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Jan J De WaeleM.D. Ph.D. 

Intensive Care Unit 1K12-C, Ghent University Hospital

De Pintelaan 185, 9000 Ghent, Belgium

Email: jan.dewaele@UGent.be

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