Chronic cholecystitis medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Furqan M M. M.B.B.S[2]

The mainstay of treatment for chronic cholecystitis is surgery. Supportive measures are instituted to prepare the patient for surgery. These include antimicrobial therapy and fluid resuscitation. If the chronic cholecystitis is superimposed by acute cholecystitis antibiotics can be used. Commonly used antibiotics are Cefazolin, Cefuroxime, and Ceftriaxone.

• The mainstay of treatment for chronic cholecystitis is surgery. Supportive measures are instituted to prepare the patient for surgery. These include antimicrobial therapy and fluid resuscitation. If the chronic cholecystitis is superimposed by acute cholecystitis antibiotics can be used. Commonly used antibiotics are Cefazolin, Cefuroxime, and Ceftriaxone.^[1]

• 1. Community-acquired acute cholecystitis of mild-to-moderate severity

• Preferred regimen (1): Cefazolin 1–2 g IV q8h
• Preferred regimen (2): Cefuroxime 1.5 g IV q8h
• Preferred regimen (3): Ceftriaxone 1–2 g IV q12–24 h

• 2. Community-acquired acute cholecystitis of severe physiologic disturbance, advanced age, or immunocompromised state

• Preferred regimen (1):Imipenem-cilastatin 500 mg IV q6h OR 1 g q8h, AND Metronidazole 500 mg IV q8–12 h OR 1500 mg q24h
• Preferred regimen (2):Meropenem 1 g IV q8h, AND Metronidazole 500 mg IV q8–12 h OR 1500 mg q24h
• Preferred regimen (3):Doripenem 500 mg IV q8h, AND Metronidazole 500 mg IV q8–12 h OR 1500 mg q24h
• Preferred regimen (4):Piperacillin-tazobactam 3.375 g IV q6h, AND Metronidazole 500 mg IV q8–12 h OR 1500 mg q24h
• Preferred regimen (5):Ciprofloxacin 400 mg IV q12h AND Metronidazole 500 mg IV q8–12 h OR 1500 mg q24h
• Preferred regimen (6):Levofloxacin 750 mg IV q24h AND Metronidazole 500 mg IV q8–12 h OR 1500 mg q24h
• Preferred regimen (7):Cefepime 2 g IV q8–12h AND Metronidazole 500 mg IV q8–12 h OR 1500 mg q24h

• 3. Acute cholangitis following bilio-enteric anastamosis of any severity

• Preferred regimen (1): Imipenem-cilastatin 500 mg IV q6h OR 1 g q8h AND Metronidazole 500 mg IV q8–12 h OR 1500 mg q24h
• Preferred regimen (2): Meropenem 1 g IV q8h, AND Metronidazole 500 mg IV q8–12 h OR 1500 mg q24h
• Preferred regimen (3): Doripenem 500 mg IV q8h, AND Metronidazole 500 mg IV q8–12 h OR 1500 mg q24h
• Preferred regimen (4): Piperacillin-tazobactam 3.375 g IV q6h, AND Metronidazole 500 mg IV q8–12 h OR 1500 mg q24h
• Preferred regimen (5): Ciprofloxacin 400 mg IV q12h AND Metronidazole 500 mg IV q8–12 h OR 1500 mg q24h
• Preferred regimen (6): Levofloxacin 750 mg IV q24h AND Metronidazole 500 mg IV q8–12 h OR 1500 mg q24h
• Preferred regimen (7): Cefepime 2 g IV q8–12h AND Metronidazole 500 mg IV q8–12 h OR 1500 mg q24h

• 4. Health care-associated biliary infection of any severity

• Preferred regimen (1): Imipenem-cilastatin 500 mg IV q6h OR 1 g q8h AND Metronidazole 500 mg IV q8–12 h OR 1500 mg q24h AND Vancomycin 15–20 mg/kg IV q8–12 h
• Preferred regimen (2): Meropenem 1 g IV q8h, AND Metronidazole 500 mg IV q8–12 h OR 1500 mg q24h AND Vancomycin 15–20 mg/kg IV q8–12 h
• Preferred regimen (3): Doripenem 500 mg IV q8h, AND Metronidazole 500 mg IV q8–12 h OR 1500 mg q24h AND Vancomycin 15–20 mg/kg IV q8–12 h
• Preferred regimen (4): Piperacillin-tazobactam 3.375 g IV q6h, AND Metronidazole 500 mg IV q8–12 h OR 1500 mg q24h AND Vancomycin 15–20 mg/kg IV q8–12 h
• Preferred regimen (5): Ciprofloxacin 400 mg IV q12h AND Metronidazole 500 mg IV q8–12 h OR 1500 mg q24h AND Vancomycin 15–20 mg/kg IV q8–12 h
• Preferred regimen (6): Levofloxacin 750 mg IV q24h AND Metronidazole 500 mg IV q8–12 h OR 1500 mg q24h AND Vancomycin 15–20 mg/kg IV q8–12 h
• Preferred regimen (7): Cefepime 2 g IV q8–12h AND Metronidazole 500 mg IV q8–12 h OR 1500 mg q24h AND Vancomycin 15–20 mg/kg IV q8–12 h

• Note(1): Antimicrobial therapy of established infection should be limited to 4–7 days, unless it is difficult to achieve adequate source control. Longer durations of therapy have not been associated with improved outcome.
• Note(2): Patients undergoing cholecystectomy for acute cholecystitis should have antimicrobial therapy discontinued within 24 h unless there is evidence of infection outside the wall of the gallbladder.

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