Studies have demonstrated usefulness of antibiotics in patients with infection associated with necrosis of the pancreas in cases where over one third of the gland is affected. Appropriate antibiotic choices are imipenem and ciprofloxacin. Indications for further intervention include uncertainty of diagnosis, impacted stone, pseudocyst, pancreatic abscess, infected necrosis and possibly sterile necrosis. Infected necrosis or abscess in a patient who is deteriorating would indicate the need for surgical debridement and antibiotics Acute pancreatitis presents with a range of clinical pictures. Most often pancreatitis in caused by alcohol ingestion and cholelithiasis.
Most patients have an interstitial pattern and do well in general.
Other patients may present with unclear clinical pictures with the diagnosis being unsuspected until autopsy or may develop necrotic pancreatitis that carries a grimmer prognosis and increases the risk for infection. Recent advances in pancreatitis models and identification of agents to interrupt the cellular and molecular events in pancreatitis may provide other treatment modalities such as gabexate and lexipifant that may be useful in treating these systemic events.