Basically patients with fluid collection and necrosis involving more than one third of the gland are at substantial risk for severe complications. Antibiotic use is something that I d like to make an argument against the literature for. We believe that in patients with necrosis and organ failure it is reasonable to initiate antibiotics that cover both anaerobes and aerobic organisms and that the literature has failed to show benefit in randomized studies in this setting has done that because the patients didn t really have severe pancreatitis or that they used the wrong antibiotics, that didn t reach the pancreatic bed. This is a list of the bacteria that are involved in This is a CT scan just showing the appearance of gas in the pancreatic bed, and once we get infective necrosis I think that it s time to get the surgeon involved. Certainly, when you get necrotizing pancreatitis without clinical improvement, it s important to distinguish whether it is infected necrosis or sterile necroses.
Infected necrosis does require surgical debridement.
Sterile necrosis however can be treated medically, at least in the initial period of 4-6 weeks. The last few slides have to do with the anti-cytokine therapy that I mentioned. Unfortunately at this time there are no drugs available that block the effects of TNF or IL-1. However, there are drugs that are coming close to market for inhibition of platelet activating factor inhibition. Again, I showed you the therapeutic window.