Acute pancreatitis is a major disease that cannot be considered self-limiting, as it has serious early and long-term impact. Interventional clinical trials of new and repurposed drugs are crucial to address the absence of a definitive, internationally licensed treatment. Many drugs, however, have a role in treating complications of acute pancreatitis or, in specific sub-groups, preventing recurrence. A definitive drug, however, would reduce complications and the adverse effects of their treatments.

Initially intravenous fluids, opiates, and oral or enteral if not parenteral nutrition are indicated; occasionally antivirals, or antivenom for scorpion stings in endemic areas.

Insulin is used in hypertriglcyeridaemia-associated acute pancreatitis, which has a range of drugs including antisense therapies in specific groups to prevent recurrence.

Inotropes maintain cardiac output and assist renal perfusion in patients with severe acute pancreatitis, but may cause gut and/or peripheral ischaemia.

Antibiotics are the mainstay to treat, but not recommended to prevent, all infection; these may be complicated by dysbiosis and/or fungal infection.

Pancreatic enzyme replacement therapy is necessary in many patients, notably after pancreatic necrosis; pancreatic endocrine insufficiency is likely to require insulin.

Interventions for source control are usually delayed for several weeks because early infection is poorly localised amid intra-abdominal inflammation and necrosis.