Acute cholecystitis medical therapy: Difference between revisions
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===Duration of therapy=== | ===Duration of therapy=== | ||
*The duration of the antibiotic in acute cholecystitis depends on the severity of the disease. | |||
**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 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. | **Antibiotic therapy is discontinued within 4-7 days for moderate-severe cholecystitis. | ||
Revision as of 17:23, 8 December 2017
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Diagnosis |
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Treatment |
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Case Studies |
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Acute cholecystitis medical therapy On the Web |
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American Roentgen Ray Society Images of Acute cholecystitis medical therapy |
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Risk calculators and risk factors for Acute cholecystitis medical therapy |
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
- Preferred regimen (1): Ampicillin/sulbactam 100 mg PO q12h for 10-21 days (Contraindications/specific instructions)
- Preferred regimen (2): Ciprofloxacin 500 mg PO q8h for 14-21 days
- Preferred regimen (3): Levofloxacin 500 mg q12h for 14-21 days
- Alternative regimen (1): Cefazolin 500 mg PO q6h for 7–10 days
- Alternative regimen (2): Cefotiam 500 mg PO q12h for 14–21 days
- 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.
- 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.