Management of Pancreatitis

Acute Pancreatitis

The American College of Emergency Physicians recommends that no specific pharmacological treatment should be given for acute pancreatitis except for organ support and nutrition 1, 2
Routine prophylactic antibiotics are NOT recommended for patients with acute pancreatitis, as they are not associated with decreased mortality or morbidity 1, 2, 3
Antibiotics should only be administered to treat documented infected acute pancreatitis, not as prophylaxis 1, 2, 3
For infected severe acute pancreatitis in immunocompetent patients without MDR colonization, meropenem, doripenem, or imipenem/cilastatin may be used 1, 2, 3
For patients with suspected MDR etiology, imipenem/cilastatin-relebactam, meropenem/vaborbactam, or ceftazidime/avibactam plus metronidazole may be used 1, 2, 3

The European Society for Clinical Nutrition and Metabolism recommends a high protein diet of 1.0-1.5 g/kg body weight for patients with chronic pancreatitis 7, 8, 6, 9, 5
A high energy diet in five to six small meals per day is recommended for patients with chronic pancreatitis 5
Fat-soluble vitamins (A, D, E, K) should be supplemented if clinical deficit is apparent 7, 8, 6, 9, 5
Vitamin D deficiency is particularly common in patients with chronic pancreatitis, and oral supplementation of 38 μg (1520 IU)/day is recommended 5
Medium chain triglycerides (MCT) can be administered due to lipase-independent absorption if adequate weight gain cannot be achieved and steatorrhea persists despite pancreatic enzyme replacement therapy (PERT) 7, 8, 6, 9, 5
Enteral nutrition (tube feeding) is indicated in approximately 5% of patients with chronic pancreatitis, and should be delivered via a jejunal tube 7, 8, 6, 9, 5
Parenteral nutrition is only indicated when enteral nutrition is not possible 7, 8, 9, 4
Analgesics should be consumed before meals to reduce postprandial pain and improve nutritional status 7, 8, 6
Standard therapeutic measures include abstinence from alcohol and pain control 7, 8, 6