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.