Acute cholecystitis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
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Acute cholecystitis Microchapters |
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Diagnosis |
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Treatment |
|
Case Studies |
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Acute cholecystitis medical therapy On the Web |
|
American Roentgen Ray Society Images of Acute cholecystitis medical therapy |
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Risk calculators and risk factors for Acute cholecystitis medical therapy |
Overview
The mainstay of treatment for acute cholecystitis is surgery. Pharmacologic medical therapy is recommended for patients with acute cholecystitis in which surgery is delayed.
Medical Therapy
- Pharmacologic medical therapy is recommended for patients with acute cholecystitis in which surgery is delayed and in complicated cases.
- Antibiotics are not indicated for the conservative management of acute calculous cholecystitis or in patients scheduled for cholecystectomy.[1]
- Empiric pharmacologic medical therapies for acute cholecystitis include either amoxicillin/clavulanic acid, cefoxitin, cefotaxime, or ceftriaxone with metronidazole, and ciprofloxacin or levofloxacin with metronidazole.
- Empirically administered antimicrobial drugs should be changed for more appropriate agents, according to the identified causative microorganisms and their susceptibility testing results.
Disease Name
- 1 Stage 1 - Mild (grade I) acute cholecystitis
- 1.1 Adult
- Oral regimens:
- Preferred regimen (1): Ampicillin/sulbactam
- Preferred regimen (2): Ciprofloxacin
- Preferred regimen (3): Levofloxacin
- Alternative regimen (1): Cefazolin
- Alternative regimen (2): Cefotiam
- Oral regimens:
- 1.1 Adult
- 2 Stage 2 - Moderate (grade II) and severe (grade III) acute cholecystitis
- 2.1 Adult
- Preferred regimen (1): Piperacillin/tazobactam 3.375 or 4.5 g IV q6h
- Preferred regimen (2): Ampicillin/sulbactam 3 g IV q6h
- Preferred regimen (3): Ceftriaxone 1 g IV q24h or 2 g IV q12h for CNS infections
- Alternative regimen (3): Levofloxacin plus metronidazole 500 or 750 mg IV q24h plus 500 mg IV q8h
- Alternative regimen (3): Ciprofloxacin plus metronidazole 400mg IV q24h plus 500 mg IV q8h
- Alternative regimen (3): Meropenem 1mg IV q6h
- Alternative regimen (3): Imipenem 500mg IV q6h
- 2.1 Adult
Add metronidazole to the preferred regimen (1), (2), and (3) if anaerobic bacteria are suspected.
Duration of therapy
- The duration of the antibiotic in acute cholecystitis depends on the severity of the disease.[2][3][4]
- Antibiotic therapy should be discontinued within 24 hours of cholecystectomy for mild cholecystitis unless there is evidence of infection extending outside of the gallbladder.
- Antibiotic therapy is discontinued within 4-7 days for moderate-severe cholecystitis.
- In the cases of bacteremia with gram-positive bacteria known to cause infective endocarditis (eg, Enterococcus spp and Streptococcus spp), consider continuing antibiotics for 14 days.
References
- ↑ "Systematic review of antibiotic treatment for acute calculous cholecystitis - van Dijk - 2016 - BJS - Wiley Online Library".
- ↑ Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ, O'Neill PJ, Chow AW, Dellinger EP, Eachempati SR, Gorbach S, Hilfiker M, May AK, Nathens AB, Sawyer RG, Bartlett JG (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". Surg Infect (Larchmt). 11 (1): 79–109. doi:10.1089/sur.2009.9930. PMID 20163262.
- ↑ Hoffmann C, Zak M, Avery L, Brown J (2016). "Treatment Modalities and Antimicrobial Stewardship Initiatives in the Management of Intra-Abdominal Infections". Antibiotics (Basel). 5 (1). doi:10.3390/antibiotics5010011. PMC 4810413. PMID 27025526.
- ↑ Gomi H, Solomkin JS, Takada T, Strasberg SM, Pitt HA, Yoshida M, Kusachi S, Mayumi T, Miura F, Kiriyama S, Yokoe M, Kimura Y, Higuchi R, Windsor JA, Dervenis C, Liau KH, Kim MH (2013). "TG13 antimicrobial therapy for acute cholangitis and cholecystitis". J Hepatobiliary Pancreat Sci. 20 (1): 60–70. doi:10.1007/s00534-012-0572-0. PMID 23340954.