Wednesday, December 23, 2015

Acute Cholecystitis Treatment


Empiric antibiotic therapy for gram-negative and anaerobic pathogens 1,2

Regimen
Dose (adult)
First choice
Monotherapy with a beta-lactam/beta-lactamase inhibitor:
*Ampicillin-sulbactam
3 g IV q6h
Piperacillin-tazobactam
3.375 or 4.5 g IV q6h
Ticarcillin-clavulanate
3.1 g IV q4h
**Combination third generation cephalosporin PLUS metronidazole:
Ceftriaxone plus
1 g IV q24h
Metronidazole
1g loading dose followed by
500 mg IV q6h
Alternative empiric regimens
***Combination fluoroquinolone PLUS metronidazole
Ciprofloxacin or
400 mg IV q12h
Levofloxacin plus
500 or 750 mg IV q24h
Metronidazole
500 mg IV q8h
Monotherapy with a carbapenem:

Imipenem-cilastatin
500 mg IV q6h
Meropenem
1 g IV q8h
Doripenem
500 mg IV q8h
Ertapenem
1 g IV q24h
Comments :
According to NAG 2014;
*First line treatment
**Alternative treatment
***Alternative to severe penicillin allergy
  • For complicated acute cholecytitis, duration= 4-7 days unless adequate source control is not achieved.
  • For uncomplicated acute cholecytis, antibiotics should be given until biliary obstruction is relieved. No post-procedure antibiotic antibiotics are necessary if the obstruction is successfully relieved.

References:
  1. NAG
  2. Up-To-Date
  3. Sanford

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