Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

H. Necrotizing PancreatitisThe published guideline made special reference to the use of antibiotics innecrotizing pancreatitis:The administration of prophylactic antibiotics to patients with severe necrotizingpancreatitis prior to the diagnosis of infection is not recommendedBroad-spectrum antibiotic therapy has been used by some clinicians for thetreatment of patients with necrotizing pancreatitis, in an effort to prevent aninfection in the inflammatory phlegmon and thereby improve patient outcome. Ina guideline on the management of severe pancreatitis, however, the authorsconcluded that this approach was not justified on the basis of available data. Ameta-analysis of trials performed in this area have shown that positive resultswere attributable to poor study design and that well-designed studies did notdemonstrate benefit .This practice is not recommended without clinicalor culture evidence of an established infection in patients with necrotizingpancreatitis. In those patients with established pancreatic infection, the agentsrecommended for use with community-acquired infection of higher severity andhealth care–associated infection are the preferred agents. Because of thedifficulty of achieving adequate source control in patients with infected pancreaticand peripancreatic phelgma, a longer duration of therapy may be needed.References:1. Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJC, BaronEJ, O’Neill PJ, Chow AW, Dellinger EP, Eachempati SR, Gorbach S,Hilfiker M, May AK, Nathens AB, Sawyer RG, Bartlett JG. Diagnosis andmanagement of complicated intra-abdominal infections in adults andchildren: Guidelines by the Surgical Infection Society and the InfectiousDiseases Society of America. Clin Infect Dis 2010;50:133-1642. UWHC Antimicrobial Use Guidelines 20 th Edition. Appendix B. SurgicalProphylaxis. 2009.