Pancreatitis medical therapy

Pancreatitis Main Page
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Classification Acute Pancreatitis Chronic Pancreatitis Hereditary Pancreatitis Autoimmune Pancreatitis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chetan Lokhande, M.B.B.S [2]

Medical Therapy

The treatment of pancreatitis will, of course, depend on the severity of the pancreatitis itself. Still, general principles apply and include

• Provision of pain relief. In the past this was done preferentially with meperidine (Demerol), but it is now not thought to be superior to any narcotic analgesic. Indeed, given meperidine's generally poor analgesic charactersitics and its high potential for toxicity, it should not be used for the treatment of the pain of pancreatitis
• Provision of adequate replacement fluids and salts (intravenously),
• Limitation of oral intake (with dietary fat restriction the most important point), and
• Monitoring and assessment for, and treatment of, the various complications listed above.
• When necrotizing pancreatitis ensues and the patient shows signs of infection it is imperative to start antibiotics such as Imipenem due to its high penetration of the drug in the pancreas.

Antibiotic therapy

As per the 2012 guidelines the treatment of pancreatitis is divided in to three groups based on the following criteria :

1. Pancreatitis without necrosis
2. Prophylactic treatment for necrotizing pancreatitis on CT scan
3. Infected pseudocyst or pancreatic abscess

Pancreatitis   ▸  Pancreatitis without necrosis   ▸  Necrotizing pancreatitis on CT scan   ▸  Infected pseudocyst or abscess Pancreatitis without necrosis ▸ No indication for an antimicrobial agent. Necrotizing pancreatitis on CT scan ≥ 30% necrosis of the pancreas on a CT scan with contrast ▸ Moxifloxacin 400 mg IV once daily ▸Imipenem 0.5-1 gm IV q6h OR ▸Meropenem 1 gm IV q8h Treat for 14 days maximum

Infected pseudocyst or pancreatic abscess While awaiting culture result ▸ Piperacillin tazobactam 3.375 gm IV q6h]] OR ▸Moxifloxacin 400 mg IV once daily