New acquisitions in treating infection due to necrotic pancreatitis: prevention or cure?

• Main Authors: Raffaele Pezzilli, Bahjat Barakat
• Format: Article
• Language: English
• Published: PAGEPress Publications 2008-06-01
• Series: Emergency Care Journal
• Online Access: http://www.pagepressjournals.org/index.php/ecj/article/view/1344

Early antibiotic treatment is still a therapeutic challenge in the clinical management of acute necrotic pancreatitis. The antibiotic of choice for the prevention of the infection of necrotic pancreatic tissue would appear to be imipenem and, more recently, meropenem has also been suggested. The latter belongs to the same family of antibiotics as imipenem but delivers greater stability in the presence of renal dehydropeptidase-I and an increase in activity against gram-negative bacteria, it offers similar efficacy to imipenem in preventing pancreatic infection and extrapancreatic infections when associated with severe acute pancreatitis. Two further studies have advised against prophylactic use of antibiotics in the prevention of acute necrotic pancreatitis. Most recently, probiotics have been suggested as useful in the prevention of pancreatic necrosis. In this paper we will critically review the most recent studies published on the prophylaxis and treatment of infected pancreatic necrosis and a critical evaluation of the same.