Acute pancreatitis: management of complicating infection.
Acute pancreatitis develops precipitously, changing the patient's condition from apparent good health to a critically ill status. Of patients who succumb, 80 per cent die from secondary infection in the pancreas-peripancreatic area. Infection supervenes in the second week or later after onset. Prophylactic antibiotic(s) appear to be helpful in avoiding, delaying, and/or lessening secondary sepsis. Once infection develops, treatment requires open debridement of necrotic material, drainage, and appropriate antibiotic therapy; or mortality will approach 100 per cent. Infecting organisms are commonly Escherichia coli, Klebsiella, Staphylococcus, Enterococcus, Bacteroides, and/or fungi. Antibiotics felt to be preferable for prophylactic therapy include 1) imipenem-cilastatin, 2) a quinolone + metronidazole, and 3) possibly an extended-spectrum penicillin. Treatment should be continued for 2 weeks or until recovery. Because fungus infections are occurring more often, prophylaxis with fluconazole may be warranted.
Laws
H L
HL
Department of Surgery, Carraway Methodist Medical Center, Birmingham, Alabama 35234, USA.
Kent
R B
RB
D000208:Acute Disease; D001424:Bacterial Infections / Q000150:complications / Q000628:therapy*; D002177:Candidiasis / Q000150:complications / Q000628:therapy*; D006801:Humans; D010182:Pancreatic Diseases / Q000150:complications / Q000628:therapy*; D010195:Pancreatitis / Q000150:complications*