Protocol for extended antibiotic therapy after laparoscopic cholecystectomy for acute calculous cholecystitis (Cholecystectomy Antibiotic Randomised Trial, CHART)

Pablo Pellegrini, Juan Pablo Campana, Agustín Dietrich, Jeremías Goransky, Juan Glinka, Diego Giunta, Laura Barcan, Fernando Alvarez, Oscar Mazza, Rodrigo Sánchez Claria, Martin Palavecino, Guillermo Arbues, Victoria Ardiles, Eduardo de Santibañes, Juan Pekolj, Martin de Santibañes, Pablo Pellegrini, Juan Pablo Campana, Agustín Dietrich, Jeremías Goransky, Juan Glinka, Diego Giunta, Laura Barcan, Fernando Alvarez, Oscar Mazza, Rodrigo Sánchez Claria, Martin Palavecino, Guillermo Arbues, Victoria Ardiles, Eduardo de Santibañes, Juan Pekolj, Martin de Santibañes

Abstract

Introduction: Acute calculous cholecystitis represents one of the most common complications of cholelithiasis. While laparoscopic cholecystectomy is the standard treatment in mild and moderate forms, the need for antibiotic therapy after surgery remains undefined. The aim of the randomised controlled Cholecystectomy Antibiotic Randomised Trial (CHART) is therefore to assess if there are benefits in the use of postoperative antibiotics in patients with mild or moderate acute cholecystitis in whom a laparoscopic cholecystectomy is performed.

Methods and analysis: A single-centre, double-blind, randomised trial. After screening for eligibility and informed consent, 300 patients admitted for acute calculus cholecystitis will be randomised into two groups of treatment, either receiving amoxicillin/clavulanic acid or placebo for 5 consecutive days. Postoperative evaluation will take place during the first 30 days. Postoperative infectious complications are the primary end point. Secondary end points are length of hospital stay, readmissions, need of reintervention (percutaneous or surgical reinterventions) and overall mortality. The results of this trial will provide strong evidence to either support or abandon the use of antibiotics after surgery, impacting directly in the incidence of adverse events associated with the use of antibiotics, the emergence of bacterial resistance and treatment costs.

Ethics and dissemination: This study and informed consent sheets have been approved by the Research Projects Evaluating Committee (CEPI) of Hospital Italiano de Buenos Aires (protocol N° 2111).

Results: The results of the trial will be reported in a peer-reviewed publication.

Trial registration number: NCT02057679.

Keywords: INFECTIOUS DISEASES; antibiotics; cholecystitis; laparoscopy; postoperative.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Figures

Figure 1
Figure 1
Trial design chart (ACC, acute calculous cholecystitis; AMC, amoxicillin/clavulanic acid; EV, endovenous; LC, laparoscopic cholecystectomy).

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