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.

Class Summary

Patients typically are bacteremic and/or septic.

Imipenem and Cilastin (Primaxin)

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

Cefuroxime (Ceftin)

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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. The condition of the patient, severity of infection, and susceptibility of microorganism determines the 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.

Ceftazidime (Ceptaz, Fortaz, Tazicef, Tazidime)

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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.

Ofloxacin (Floxin)

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

Ticarcillin, clavulanate potassium (Timentin)

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

Piperacillin/Tazobactam (Zosyn)

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

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Media Gallery

Contrast-enhanced CT scan of an infected pancreatic pseudocyst.

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Author

Abraham Mathew, MD, MS Professor of Medicine, Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hershey Medical Center, Pennsylvania State University College of Medicine

Abraham Mathew, MD, MS is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Received ownership interest from Hershey Endoscopy Center for partner of ambulatory surgery center, practice site; Received consulting fee from Boston Scientific for consulting.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

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, American Gastroenterological Association

Disclosure: Received grant/research funds from Novartis for other; Received grant/research funds from Bayer for other; Received grant/research funds from Otsuka for none; Received grant/research funds from Bristol Myers Squibb for other; Received none from Scynexis for none; Received grant/research funds from Salix for other; Received grant/research funds from MannKind for other.

Chief Editor

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Acknowledgements

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.

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.