Antibiotics and Probiotics

Acute pancreatitis (AP) begins as a sterile inflammation within the pancreatic parenchyma that is triggered by acinar cell injury. Around 15–20% of the patients with AP develop pancreatic and/or extrapancreatic fat necrosis, out of which a proportion of susceptible patients get primary infected pancreatic necrosis (IPN). The other potential and occasionally underrecognized infections seen in patients with AP are urinary tract infection (UTI), pneumonia, including ventilator-associated pneumonia (VAP), cholangitis, sepsis, intravenous (IV) catheter site infections, and secondary IPN. Therefore, antibiotics have a role in the management of complications of AP. While there is no confusion with the use of therapeutic antibiotics for the septic indications stated above, there remains a lack of clarity with the use of prophylactic and empirical antibiotics. This possibly results in erring toward early use of prophylactic antibiotics in real-life clinical practice despite most guidelines recommending the contrary.