Several classifications exist for prediction of acute pancreatitis severity. A commonly used classification system (the Atlanta classification) divides acute pancreatitis into two broad categories:
- Mild (edematous and interstitial acute) pancreatitis.
- Severe (usually referred to as “acute necrotizing”) pancreatitis. For detailed guidance on staging please refer to VIHA online resources such as Up-To-Date.
MILD – MODERATE
No prophylactic or empiric antibiotic therapy is required unless there is a documented infection.
- The administration of prophylactic antibiotics to patients with severe necrotizing pancreatitis prior to the diagnosis of infection is NOT recommended.
- Initiate antimicrobial therapy in proven secondary infection or when the patient is hemodynamically unstable and requiring vasopressors.
- It not possible to differentiate necrotizing pancreatitis from infected necrotizing pancreatitis on the basis of a CT scan alone. Fine needle aspirate is required.
- Surgical debridement and drainage with culture is essential for established infections.
- Blood cultures recommended (high risk of bacteremia).
Coagulase negative Staphylococcus
Recommended Empiric Therapy (Duration based on clinical improvement)
Piperacillin-tazobactam 3.375 g IV q6h OR Imipenem 500 mg IV q6h
Penicillin allergic (clear history)
Ciprofloxacin 400 mg IV q12h + Metronidazole 500 mg IV q8h + Vancomycin 15 mg/kg (round to nearest 250 mg) IV q12h.
Adjust vancomycin interval based on GFR.