ACUTE NECROTIZING PANCREATITIS: PATHOGENESIS ANTIBIOTIC PROPHYLAXIS AND MANAGEMENT

Acute necrotizing pancreatitis (ANP) can have severe complications and high mortality despite treatment. The main causes of acute pancreatitis (AP) are gallstones, alcohol abuse, hypercalcemia, hypertriglyceridemia and various types of drugs. Of ANP infected necrosis and abscess involve enteric bacteria with Escherichia coli most common followed by Staphylococci and enter ococci included. Infecting micro flora can be monomicrobial or polymicrobial. Mortality in severe ANP up to 50% duringthe first weekis associated with multiple organ failure due to systemic infections. Prophylactic antibiotics in ANP are controversial. Some data prior to last negative trial of meropenem suggested the use of antibiotics if computed tomography (CT) scan showed more than 30% necrosis of pancreas. Recent data in a randomized double blind placebo controlled study found no significant difference between the outcome of two groups of patients with ANP, one receiving meropenem and the other placebo. More trials are needed to confirm whether prophylactic antibiotics are beneficial in ANP.