Pancreatic Necrosis and Pancreatic Abscess Medication

  • Author: Alan BR Thomson, MD; Chief Editor: Julian Katz, MD   more...
 
Updated: Jul 15, 2010
 

Medication Summary

Antibiotics are the primary medical therapy in pancreatic abscess, used for the control of bacteremia and sepsis. Supportive care with fluids is needed, and the use of vasopressors may be required.

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Antibiotics

Class Summary

Patients typically are bacteremic and/or septic.

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Imipenem and Cilastin (Primaxin)

 

DOC because of broad coverage, excellent penetration, and best clinical data to support use.

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Cefuroxime (Ceftin)

 

Second-generation cephalosporin maintains gram-positive activity that first-generation cephalosporins have; adds activity against P mirabilis, Haemophilus influenzae, E coli, K pneumoniae, and Moraxella catarrhalis. Condition of patient, severity of infection, and susceptibility of microorganism determines proper dose and route of administration. Shown in clinical trials to decrease mortality rates in ANP. Whether antioxidant effect may play a role in efficacy is questionable.

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Ceftazidime (Ceptaz, Fortaz, Tazicef, Tazidime)

 

Third-generation cephalosporin with broad coverage and better gram-negative coverage than cefuroxime. Has antipseudomonal activity; however, resistance to ceftazidime is as high as 15%. Some data support use in combination with amikacin and metronidazole in ANP.

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Ofloxacin (Floxin)

 

A pyridine carboxylic acid derivative with broad-spectrum bactericidal effect. All quinolones have good activity against common flora found in pancreatic abscess, with exception of Candida species.

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Ticarcillin, clavulanate potassium (Timentin)

 

Extended-spectrum penicillin. Inhibits biosynthesis of cell-wall mucopeptide and is effective during stage of active growth.

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Piperacillin/Tazobactam (Zosyn)

 

An extended-spectrum penicillin. Inhibits biosynthesis of cell-wall mucopeptide and is effective during stage of active multiplication.

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Contributor Information and Disclosures
Author

Alan BR Thomson, MD  Professor of Medicine, Division of Gastroenterology, University of Alberta, Canada

Alan BR Thomson, MD is a member of the following medical societies: Alberta Medical Association, American College of Gastroenterology, American Gastroenterological Association, Canadian Association of Gastroenterology, Canadian Medical Association, College of Physicians and Surgeons of Alberta, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Coauthor(s)

Eric R Frizzell, MD  Instructor of Medicine, Uniformed Services University of the Health Sciences; Consulting Staff, Department of Medicine, Division of Gastroenterology, Walter Reed Army Medical Center

Eric R Frizzell, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Specialty Editor Board

Jose A Perez Jr, MD, MSEd, MBA  Residency Director, Vice Chair of Education, Department of Medicine, Methodist Hospital, Houston; Associate Professor of Clinical Medicine, Weill Cornell Medical College

Jose A Perez Jr, MD, MSEd, MBA, is a member of the following medical societies: American College of Physician Executives, American College of Physicians, Society of General Internal Medicine, and Society of Hospital Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Douglas M Heuman, MD, FACP, FACG, AGAF  Chief of Hepatology, Hunter Holmes McGuire Department of Veterans Affairs Medical Center; Professor, Department of Internal Medicine, Division of Gastroenterology, Virginia Commonwealth University School of Medicine

Douglas M Heuman, MD, FACP, FACG, AGAF is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Physicians, and American Gastroenterological Association

Disclosure: Nothing to disclose.

Alex J Mechaber, MD, FACP  Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine

Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD  Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

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Contrast-enhanced CT scan of infected pancreatic pseudocyst.
 
 
 
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