The management of infected necrotizing pancreatitis has dramatically evolved with continuous growing expertise and ongoing research efforts. More aggressive treatment procedures can exacerbate the important inflammatory response associated with infected necrotizing pancreatitis. Therefore, the use of conservative and less invasive interventional strategy results in a clear improvement of outcomes. The optimal treatment strategy to consider may be different for each patient because of heterogenous condition. Indeed, The optimal treatment approach should be based on a multidisciplinary discussion including gastroenterologist, surgeon, radiologist, and anesthetist. The step-up approach is currently the preferred treatment strategy to treat infected necrotizing pancreatitis. However, optimal timing of intervention remains unclear with lack of consensus. This review provides an overview on the use of the step-up approach to treat infected necrotizing pancreatitis, in the light of the recent published reports.