There has been steady improvement in the evaluation and treatment of acute pancreatitis. Use of assessment criteria such as the Ranson score, in combination with CE-CT and percutaneous aspiration for the diagnosis of infection, allows for optimal use of surgical and medical therapy. B. The Use of Antibiotics in Pancreatitis 1.
Infection is the leading cause of death in severe pancreatitis.
However, early trials with prophylactic antibiotic therapy with ampicillin showed no benefit for patients with acute pancreatitis. Since that time much as been learned about the penetration of antibiotics into normal and inflamed pancreatic tissues and secretions, including the fact that ampicillin is nearly undetectable in pancreatic tissue or pancreatic secretions. All of the patients had necrotizing pancreatitis with Ranson scores ranging from 3 to 6. The investigators chose cefuroxime, based on its activity against Escherichia coli and Staphylococcus aureus isolates in their hospital, acknowledging that there are limited data on the penetration of this particular antibiotic into pancreatic tissue. The investigators were forced to change from cefuroxime to alternative antibiotics in two thirds of cases, and to initiate antibiotic therapy on the basis of presumed or documented infection in 23 of 30 patients initially randomised to no therapy.