Pii: S0140673695922806

can improve outcome. 30 patients were assigned cefuroxime (4&middot;5 g/day intravenously) from admission. In the second group, no antibiotic treatment was given until clinical or microbiologically verified infection or after a secondary rise in C-reactive protein. The inclusion criteria were C-reactive protein concentration above 120 mg/L within 48 h of admission and low enhancement (<30 Hounsfield units) on contrast-enhanced computed tomography. There were more infectious complications in the non-antibiotic than in the antibiotic group (mean per patient 1&middot;8 vs 1&middot;0, p=0&middot;01). The most common cause of sepsis was Staphylococcus epidermidis; positive cultures were obtained from pancreatic necrosis or the central venous line in 14 of 18 patients with suspected but blood-culture-negative sepsis. Mortality was higher in the non-antibiotic group (seven vs one in the antibiotic group; p=0&middot;03). Four of the eight patients who died had cultures from pancreatic necrosis positive for Staph epidermidis. We conclude that cefuroxime given early in necrotising pancreatitis is beneficial and may reduce mortality, probably by decreasing the frequency of sepsis. Introduction Despite advances in the treatment of severe acute pancreatitis, mortality remains high. Lower mortality has been achieved as a result of improvements in operative treatment and intensive care.1.2 Treatment with pancreatic enzyme inhibitors has been disappointing and there have been few investigations of prophylactic antibiotic therapy. 1-; An early report suggested that prophylactic antibiotics conferred no benefit.3 Adequate assessment of the severity of pancreatitis has been a substantial difficulty in the past, and comparison of the results of different studies has been almost impossible. New radiological and laboratory methods now, however, allow analysis of the degree of severity with acceptable accuracy.8-14 Although the overall mortality rate of pancreatitis has decreased, infectious complications have been reported to indicate a poor outcome.15,16 Among patients treated in intensive-care units, the species reported to cause most