Antibiotic use in acute cholecystitis: Practice patterns in the absence of evidence-based guidelines
ABSTRACT Antibiotics are frequently administered in acute cholecystitis for preoperative prophylaxis or postoperative treatment. The optimal timing, choice, and duration of antibiotics are unclear.
We conducted a retrospective review of all cases of acute cholecystitis between 1996 and 2001 at the American University of Beirut Medical Centre. A survey among general surgeons was also performed to describe the pattern of antibiotic prescribing in uncomplicated acute cholecystitis. A MEDLINE search for guidelines for antibiotic use in acute cholecystitis was conducted.
The number of cases of acute cholecystitis was 79. The mean duration of postoperative antibiotic therapy was 5 days. There was no correlation between the severity of symptoms, gallbladder description, or positive gallbladder culture and the use of antibiotics postoperatively. Sixty five percent of interviewed surgeons would continue antibiotic therapy postoperatively for 3 or more days. Search of the medical literature failed to provide clear guidelines for antibiotic use in acute cholecystitis.
The use of antibiotics in patients with acute cholecystitis is erratic and costly. Prospective studies are needed to better study the effectiveness of a short course of antibiotics in uncomplicated cases. The role of gallbladder culture in guiding antibiotic therapy should be defined as routine cultures add to the cost without evident benefit.
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ABSTRACT: Procedure-Specific Therapy for Cholecystitis The main part of nonsurgical therapy of acute cholecystitis is analgesia. Antibiotics and also fasting in the beginning play an important role. For pain medication several drugs are available, the most suitable are non-acid antipyretic analgesics out of the WHO analgesic step-ladder 1. The primary therapy is the cholecystectomy. The gold standard is laparoscopic cholecystectomy in a maximum delay of 24-72 h after onset of symptoms. For patients with acalculous cholecystitis in intensive care units the use of percutaneous transhepatic drainage of the gallbladder may be more suitable than the operative approach.Chirurgische Gastroenterologie 01/2007; 23(1):19-22. DOI:10.1159/000097473 · 0.05 Impact Factor
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ABSTRACT: Aim: We conducted a multicenter trial to evaluate the efficacy and safety of i.v. doripenem (DRPM), a new class of carbapenem, in patients with moderate to severe biliary tract infection based on severity assessment using the Guidelines for the Management of Acute Cholangitis and Cholecystitis (1st Edition). Methods: One hundred and nineteen patients with moderate to severe acute cholangitis and/or cholecystitis were subjected to this study. After the initial collection of bile, patients were administrated DRPM 0.5 g three times daily by i.v. drip infusion. Results: The characteristics of the 119 patients were well balanced, including 60 with cholangitis, 44 with cholecystitis and 15 with cholangitis complicated by cholecystitis; there were 88.2% (105/119) moderate cases and 11.8% (14/119) severe. Based upon the assumption of the use of bile drainage, the rate of response to DRPM was 92.4% (110/119) in the group of all patients. The clinical response rates were 95.0% (57/60) for cholangitis, 93.2% (41/44) for cholecystitis and 80% (12/15) for cholangitis complicated by cholecystitis. Also, the clinical response rate was 80% (8/10) in 10 patients without drainage. In contrast, bacteriological efficacy was assessed in 50 patients, and the response rates were 87.0% (20/23) in patients with cholangitis, 100% (20/20) in patients with cholecystitis and 85.7% (6/7) in patients with cholangitis complicated by cholecystitis. Adverse events were found in six patients (5.0%), but were not serious and disappeared after treatment. Conclusion: These findings suggest that DPRM is useful as a new option for moderate to severe biliary tract infection.Hepatology Research 04/2011; 41(4):340-349. DOI:10.1111/j.1872-034X.2011.00783.x · 2.74 Impact Factor
Article: Lithiase biliaire[Show abstract] [Hide abstract]
ABSTRACT: L’abstention thérapeutique est recommandée pour une lithiase vésiculaire asymptomatique. Le diagnostic de cholécystite aiguë lithiasique repose sur la clinique, la biologie et l’échographie abdominale. Le traitement recommandé est la cholécystectomie cœlioscopique le plus rapidement possible après le début de la maladie, sauf pour les formes sévères avec signes généraux où une cholécystostomie percutanée associée à l’antibiothérapie doit être discutée. Les performances diagnostiques de l’échographie pour le diagnostic de lithiase de la voie biliaire principale sont médiocres : un examen plus performant comme la bili-IRM ou l’écho-endoscopie est souvent nécessaire en deuxième intention. Le traitement de l’angiocholite lithiasique repose sur l’antibiothérapie et le drainage biliaire. Les traitements de la lithiase de la voie biliaire principale par voie cœlioscopique et par traitement combiné (sphinctérotomie endoscopique [SE] associée à une cholécystectomie cœlioscopique) donnent des résultats équivalents quand ils sont réalisés par des professionnels entraînés. Le choix de la technique doit dépendre des compétences locales.La Presse Médicale 06/2011; 40(6):567–580. DOI:10.1016/j.lpm.2011.01.024 · 1.08 Impact Factor