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