Severe pancreatitis develops in 15% to 20% of patients with acute pancreatitis, morphologically characterized by extra- and intrapancreatic necrosis and associated with single or multiple organ failure. It is well accepted that surgery is indicated in patients with infected pancreatic necrosis. However, management of sterile necrosis is still controversial. In a prospective study, we evaluated the effect of maximal intensive care unit (ICU) treatment combined with prophylactic antibiotics in patients with necrotizing pancreatitis.