Antimicrobial therapy for acute cholecystitis: Tokyo Guidelines

Journal of Hepato-Biliary-Pancreatic Sciences, Jan 2007

Acute cholecystitis consists of various morbid conditions, ranging from mild cases that are relieved by the oral administration of antimicrobial drugs or that resolve even without antimicrobials to severe cases complicated by biliary peritonitis. Microbial cultures should be performed by collecting bile at all available opportunities to identify both aerobic and anaerobic organisms. Empirically selected antimicrobials should be administered. Antimicrobial activity against potential causative organisms, the severity of the cholecystitis, the patient’s past history of antimicrobial therapy, and local susceptibility patterns (antibiogram) must be taken into consideration in the choice of antimicrobial drugs. In mild cases which closely mimic biliary colic, the administration of nonsteroidal anti-inflammatory drugs (NSAIDs) is recommended to prevent the progression of inflammation (recommendation grade A). When causative organisms are identified, the antimicrobial drug should be changed for a narrower-spectrum antimicrobial agent on the basis of the species and their susceptibility testing results.

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Antimicrobial therapy for acute cholecystitis: Tokyo Guidelines

Masahiro Yoshida 10 Tadahiro Takada 10 Yoshifumi Kawarada 9 Atsushi Tanaka 8 Yuji Nimura 15 Harumi Gomi 14 Masahiko Hirota 13 Fumihiko Miura 10 Keita Wada 10 Toshihiko Mayumi 12 Joseph S. Solomkin 17 Steven Strasberg 16 Henry A. Pitt 11 Jacques Belghiti 6 Eduardo de Santibanes 7 Sheung-Tat Fan 4 Miin-Fu Chen 5 Giulio Belli 2 Serafin C. Hilvano 3 Sun-Whe Kim 0 Chen-Guo Ker 1 0 Department of Surgery, Seoul National University College of Medicine , Seoul, Korea 1 Division of HPB Surgery, Yuan's General Hospital , Taoyuan, Taiwan 2 Department of General and HPB Surgery, Loreto Nuovo Hospital , Naples, Italy 3 Department of Surgery, Philippine General Hospital, University of the Philippines , Manila, Philippines 4 Department of Surgery, The University of Hong Kong , Hong Kong, China 5 Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University , Taoyuan, Taiwan 6 Department of Digestive Surgery and Transplantation, Hospital Beaujon , Clichy, France 7 Department of Surgery, University of Buenos Aires , Buenos Aires, Argentina 8 Department of Medicine, Teikyo University School of Medicine , Tokyo, Japan 9 Mie University School of Medicine , Mie, Japan 10 Department of Surgery, Teikyo University School of Medicine , 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan 11 Department of Surgery, Indiana University School of Medicine , Indianapolis, USA 12 Department of Emergency Medicine and Critical Care, Nagoya University School of Medicine , Nagoya, Japan 13 Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Science , Kumamoto, Japan 14 Division of Infection Control and Prevention, Jichi Medical University Hospital , Tochigi, Japan 15 Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine , Nagoya, Japan 16 Department of Surgery, Washington University in St Louis and Barnes-Jewish Hospital , St Louis, USA 17 Department of Surgery, Division of Trauma and Critical Care, University of Cincinnati College of Medicine , Cincinnati, USA Acute cholecystitis consists of various morbid conditions, ranging from mild cases that are relieved by the oral administration of antimicrobial drugs or that resolve even without antimicrobials to severe cases complicated by biliary peritonitis. Microbial cultures should be performed by collecting bile at all available opportunities to identify both aerobic and anaerobic organisms. Empirically selected antimicrobials should be administered. Antimicrobial activity against potential causative organisms, the severity of the cholecystitis, the patient's past history of antimicrobial therapy, and local susceptibility patterns (antibiogram) must be taken into consideration in the choice of antimicrobial drugs. In mild cases which closely mimic biliary colic, the administration of nonsteroidal anti-inflammatory drugs (NSAIDs) is recommended to prevent the progression of inflammation (recommendation grade A). When causative organisms are identified, the antimicrobial drug should be changed for a narrower-spectrum antimicrobial agent on the basis of the species and their susceptibility testing results. - Acute cholecystitis consists of various morbid conditions, ranging from mild cases that are relieved by the oral administration of antimicrobial drugs or that resolve even without antimicrobials to severe cases complicated by biliary peritonitis, each of which requires a different treatment strategy. Decisions on antimicrobial therapy must be based upon knowledge of the likely infecting microorganisms, the pharmacokinetics/pharmacodynamics and adverse reactions/effects of available agents, and the results of local antimicrobial susceptibility testing (local antibiogram). The severity of illness and history of exposure to antimicrobials are also key factors in determining appropriate therapy. Once presumptive antimicrobial agents are selected and administered, they should be changed for more appropriate agents, based on the organisms identified and their susceptibility testing results. Continuous use of unnecessarily broader-spectrum agents should be avoided to prevent the emergence of antimicrobial resistance. Furthermore, the duration of therapy should be strictly evaluated periodically to avoid unnecessarily prolonged use of antimicrobial agents. In this article we discuss the medical treatment strategy, including antimicrobial therapy, for acute cholecystitis. In an extensive literature search, we were faced with the fact that there were very few, if any, randomized controlled trials (RCTs) of antimicrobial therapy for acute cholecystitis. Therefore, we propose consensus-based and in vitro activities-based guidelines for empirical antimicrobial therapy for acute cholecystitis. The text is organized in a question and recommendation format. Q1. What microbiological studies should be performed in acute cholecystitis? Bile and blood culture should be performed at all available opportunities, especia (...truncated)


This is a preview of a remote PDF: https://link.springer.com/content/pdf/10.1007%2Fs00534-006-1160-y.pdf

Masahiro Yoshida, Tadahiro Takada, Yoshifumi Kawarada, Atsushi Tanaka, Yuji Nimura, Harumi Gomi, Masahiko Hirota, Fumihiko Miura, Keita Wada, Toshihiko Mayumi, Joseph S. Solomkin, Steven Strasberg, Henry A. Pitt, Jacques Belghiti, Eduardo de Santibanes, Sheung-Tat Fan, Miin-Fu Chen, Giulio Belli, Serafin C. Hilvano, Sun-Whe Kim, Chen-Guo Ker. Antimicrobial therapy for acute cholecystitis: Tokyo Guidelines, Journal of Hepato-Biliary-Pancreatic Sciences, 2007, pp. 83-90, Volume 14, Issue 1, DOI: 10.1007/s00534-006-1160-y