Antimicrobial therapy for acute cholecystitis: Tokyo Guidelines

Abstract

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.

Figures

Fig. 1

Clinical question, “Should the biliary penetration of antimicrobial agents be considered important in their selection in moderate or severe acute cholecystitis?” Responses at the International Consensus Meeting. Responses from Japanese panelists and panelists from abroad showed that 78% (21/27) and 39% (9/23), respectively, answered “Yes” to the question

Fig. 2

Clinical question: “Should empirically administered antimicrobial drugs be changed for more appropriate agents according to the identified causative microorganisms and their sensitivity to antimicrobials?” Responses at the International Consensus Meeting. Responses from Japanese panelists and panelists from abroad showed that 100% (28/28) and 39% (20/23), respectively, answered “Yes” to the question