Antibiotics and pancreatitis

Despite improvements in the general supportive care of patients with acute pancreatitis, the morbidity of infectious complications remains high and bacterial infections account for most deaths. The role of antibiotics in reducing infectious morbidity and mortality has been debated for decades because of a lack of supportive clinical data. Research completed over the past decade has helped to define the microbiology, establish the risk factors, and improve the understanding of the pathogenesis of infectious complications in patients with acute pancreatitis. Patients with acute necrotizing pancreatitis are at the greatest risk of developing an infection with enteric gram-negative or gram-positive bacteria translocated from the bowel lumen into the necrotic pancreatic tissue. The most effective antimicrobial agents are the fluoroquinolones, imipenem-cilastatin, and metronidazole, which achieve adequate penetration into pancreatic juice and necrotic tissue and inhibit the growth of enteric bacteria. Animal and human studies support the use of antibiotics for the prevention of infectious morbidity and mortality in severe acute pancreatitis. Recent clinical trials have assessed the role of both systemic antibiotic prophylaxis and selective bowel decontamination with nonabsorbable oral antimicrobials in high-risk patients with acute necrotizing pancreatitis. This article provides an overview of our current knowledge of pancreatic infections and a critical analysis of studies on the role of antibiotics in this disease.