How Long Is Antibiotic Therapy Necessary After Urgent Cholecystectomy for Acute Cholecystitis?

Abstract

Antibiotic treatment over 4 days after early cholecystectomy provides no advantage in decreasing surgical site infection incidence.

Piocolecisto y tratamiento antibiótico posoperatorio: ¿indicación o tradición?

“…En estudios previos se ha demostrado que la erradicación del foco infeccioso es la base para controlar la infección intraabdominal y que, siempre que se cumpla esta condición, los ciclos cada vez más cortos de antibióticos son suficientes y efectivos [6][7][8][9][10] .…”

“…Sin embargo, conociendo la fisiopatología de la entidad 3 y teniendo en cuenta que la cirugía erradica el foco infeccioso 4,5, una vez practicada la colecistectomía, el tiempo de tratamiento antibiótico posoperatorio es materia de discusión y en algunos trabajos previos se ha explorado este tema con la premisa de que ciclos Rev Colomb Cir. 2017;32:22-25 cortos de antibiótico pueden ser igual de efectivos que ciclos mayores en la prevención de la infección del sitio operatorio e, incluso, se ha planteado si es necesario administrar algún antibiótico, más allá de la cirugía en colecistitis aguda [6][7][8][9][10] .…”

Role of antibiotics on surgical site infection in cases of open and laparoscopic cholecystectomy: A comparative observational study

“…[11] One of the studies says that whether it is high risk or low risk procedures, antibiotic prophylaxis may not affect or control the surgical site infection. [12] A study by Yan C suggest that there is no significant risk reduction with prophylactic antibiotics.…”

Surgical management of acute cholecystitis

“…In another RCT of 203 patients with acute cholecystitis, antibiotic administration up to 7 days postoperatively was not superior to antibiotic administration for just the first 12 h postoperatively [61]. In an observational study of 287 patients with moderate acute cholecystitis, antibiotic treatment for 4 days after early cholecystectomy did not decrease the incidence of surgical site infections when compared to patients who received antibiotics postoperatively for 0 to 4 days [59]. In an RCT of 414 patients, after early laparoscopic cholecystectomy for mild or moderate acute cholecystitis, lack of postoperative antibiotics did not result in a greater incidence of postoperative infections compared to patients who received antibiotics postoperatively for 5 days [28].…”

“…When there is a pericholecystic abscess, perforation, emphysematous changes or necrosis of the gallbladder wall noted during cholecystectomy, the Tokyo guidelines recommend continuation of antibiotics for 4 to 5 days and for a minimum 2 weeks if there is gram-positive bacteremia. However, there is a dearth of controlled studies addressing the benefits and duration of postoperative antibiotics [27,59]. Also, there is controversy regarding the need for antibiotics in mild acute cholecystitis [27].…”