Fever-based antibiotic therapy for acute cholangitis following successful endoscopic biliary drainage

Kogure, Hirofumi; Tsujino, Takeshi; Yamamoto, Keisuke; Mizuno, Suguru; Yashima, Yoko; Yagioka, Hiroshi; Kawakubo, Kazumichi; Sasaki, Takashi; Hirano, Keisuke; Sasahira, Naoki; Isayama, Hiroyuki; Tada, Minoru; Kawabe, Takao; Omata, Masao; Harada, Sohei; Ota, Yasuo; Koike, Kazuhiko

doi:10.1007/s00535-011-0451-5

Cited by 40 publications

(43 citation statements)

References 24 publications

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“…Dooley et al recommended 7e10 days of treatment [5], although their recommendation also was not based on clinical evidence. Kogure et al proposed a fever-based approach, where antimicrobial agents were discontinued after defervescence for 2 days after successful endoscopic drainage [11]. However, this relatively small study was a case series comprising only 18 patients, with no control group for comparison.…”

Section: Discussionmentioning

confidence: 99%

Shorter duration of antibiotic treatment for acute bacteraemic cholangitis with successful biliary drainage: a retrospective cohort study

Doi

Morimoto

Iwata

2018

Clinical Microbiology and Infection

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Section: Discussionmentioning

confidence: 99%

Shorter duration of antibiotic treatment for acute bacteraemic cholangitis with successful biliary drainage: a retrospective cohort study

Doi

Morimoto

Iwata

2018

Clinical Microbiology and Infection

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“…van Lent et al reported that in their single institution, there were no differences in the recurrence rate for acute cholangitis between the patients who received less than 3‐day therapy versus more than 5‐day therapy once the source of infection was controlled among patients with acute cholangitis. Kogure et al conducted a prospective observational study to investigate how long antimicrobial therapy should be administered for patients with acute cholangitis after successful biliary drainage. In this study, 18 patients were analyzed for recurrent cholangitis within 3 days after discontinuing antimicrobial therapy.…”

Section: How Should Highly Resistant Causative Organisms Be Managed Imentioning

confidence: 99%

Tokyo Guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis

Gomi

Solomkin

Schlossberg

et al. 2018

J Hepato Biliary Pancreat

298

249

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Antimicrobial therapy is a mainstay of the management for patients with acute cholangitis and/or cholecystitis. The Tokyo Guidelines 2018 (TG18) provides recommendations for the appropriate use of antimicrobials for community-acquired and healthcare-associated infections. The listed agents are for empirical therapy provided before the infecting isolates are identified. Antimicrobial agents are listed by classdefinitions and TG18 severity grade I, II, and III subcategorized by clinical settings. In the era of emerging and increasing antimicrobial resistance, monitoring and updating local antibiograms is underscored. Prudent antimicrobial usage and early de-escalation or termination of antimicrobial therapy are now important parts of decision-making. What is new in TG18 is that the duration of antimicrobial therapy for both acute cholangitis and cholecystitis is systematically reviewed. Prophylactic antimicrobial usage for elective endoscopic retrograde cholangiopancreatography is no longer recommended and the section was deleted in TG18. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.

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“…18 The duration of fever was the period between initiation of antibiotics and the day when a body temperature of <37°C was maintained for 24 hours. 19 Nosocomial infection was defined as infection which occurred more than 48 hours after administration or infection which occurred less than 48 hours after admission in patients who had been transferred from another hospital.…”

Section: Definitionsmentioning

confidence: 99%

Impact of the Sensitivity to Empiric Antibiotics on Clinical Outcomes after Biliary Drainage for Acute Cholangitis

et al. 2020

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Background/Aims: Empiric antibiotics are given in combination with biliary drainage for acute cholangitis but sometimes turn out to be insensitive to microorganisms in blood and bile. Clinical outcomes were compared according to sensitivity to microorganisms detected in blood and bile culture to evaluate the impact of sensitivity to empiric antibiotics in cholangitis. Methods: Consecutive patients who underwent biliary drainage for acute cholangitis were retrospectively studied. Clinical outcomes such as 30-day mortality, length of hospital stay and high care unit stay, organ dysfunction and duration of fever were compared in three groups: group A (sensitive to both blood and bile culture), group B (sensitive to blood culture alone) and group C (insensitive to both blood and bile culture). Results: Eighty episodes of cholangitis were classified according to sensitivity results: 42, 32 and six in groups A, B and C. Escherichia coli and Klebsiella were two major pathogens. There were no significant differences in 30-day mortality rate (7%, 0%, and 0%, p=0.244), length of hospital stay (28.5, 21.0, and 20.5 days, p=0.369), organ dysfunc tion rate (14%, 25%, and 17%, p=0.500), duration of fever (4.3, 3.2, and 3.5 days, p=0.921) and length of high care unit stay (1.4, 1.2, and 1.7 days, p=0.070) in groups A, B and C. Empiric antibiotics were changed in 11 episodes but clinical outcomes appeared to be non-inferior even in 31 episodes of cholangitis who were on inadequate antibiotics throughout the course. Conclusions: Sensitivity of empiric antibiotics was not associated with clinical outcomes in acute cholangitis.

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Fever-based antibiotic therapy for acute cholangitis following successful endoscopic biliary drainage

Abstract: Fever-based antibiotic therapy for acute cholangitis is safe and effective when resolution of fever is achieved following endoscopic biliary drainage.

Cited by 40 publications

References 24 publications

Shorter duration of antibiotic treatment for acute bacteraemic cholangitis with successful biliary drainage: a retrospective cohort study

Shorter duration of antibiotic treatment for acute bacteraemic cholangitis with successful biliary drainage: a retrospective cohort study

Tokyo Guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis

Impact of the Sensitivity to Empiric Antibiotics on Clinical Outcomes after Biliary Drainage for Acute Cholangitis

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