Pancreatic Necrosis and Pancreatic Abscess Medication

Updated: Jul 01, 2021
  • Author: Abraham Mathew, MD, MS; Chief Editor: BS Anand, MD  more...
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Medication

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.

Imipenem and Cilastin (Primaxin)

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

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. 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)

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)

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)

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

Piperacillin/Tazobactam (Zosyn)

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

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