Chronic cholecystitis medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Furqan M M. M.B.B.S[2]

Overview

The mainstay of treatment for chronic cholecystitis is surgery. Supportive measures are instituted to prepare the patient for surgery. These include antimicrobial therapy and fluid resuscitation. If the chronic cholecystitis is superimposed by acute cholecystitis antibiotics can be used. Commonly used antibiotics are Cefazolin, Cefuroxime, and Ceftriaxone.

Medical Therapy

  • The mainstay of treatment for chronic cholecystitis is surgery. Supportive measures are instituted to prepare the patient for surgery. These include antimicrobial therapy and fluid resuscitation. If the chronic cholecystitis is superimposed by acute cholecystitis antibiotics can be used. Commonly used antibiotics are Cefazolin, Cefuroxime, and Ceftriaxone.[1]

Antimicrobial regimens

  • 1. Community-acquired acute cholecystitis of mild-to-moderate severity
  • Preferred regimen (1): Cefazolin 1–2 g IV q8h
  • Preferred regimen (2): Cefuroxime 1.5 g IV q8h
  • Preferred regimen (3): Ceftriaxone 1–2 g IV q12–24 h
  • 2. Community-acquired acute cholecystitis of severe physiologic disturbance, advanced age, or immunocompromised state
  • 3. Acute cholangitis following bilio-enteric anastamosis of any severity
  • 4. Health care-associated biliary infection of any severity
  • Note(1): Antimicrobial therapy of established infection should be limited to 4–7 days, unless it is difficult to achieve adequate source control. Longer durations of therapy have not been associated with improved outcome.
  • Note(2): Patients undergoing cholecystectomy for acute cholecystitis should have antimicrobial therapy discontinued within 24 h unless there is evidence of infection outside the wall of the gallbladder.

References

  1. Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ; et al. (2010). "Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America". Clin Infect Dis. 50 (2): 133–64. doi:10.1086/649554. PMID 20034345.


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