From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
For choledocolithiasis in patients with penicillin allergy, ciprofloxacin is often the best antibiotic choice, with a recommended dosage of 500 mg orally twice daily or 400 mg intravenously every 12 hours, typically for 3 days or less, as supported by a recent study 1. This recommendation is based on the effectiveness of ciprofloxacin against most gram-negative bacteria commonly associated with biliary infections, its good penetration into the biliary system, and its general tolerability. Alternative options include:
- Levofloxacin: 750 mg orally or IV once daily
- Metronidazole: 500 mg orally or IV every 8 hours (often combined with a fluoroquinolone for broader coverage) When using these antibiotics, it is essential to monitor for side effects such as tendon inflammation with fluoroquinolones or neurological symptoms with metronidazole, and adjust dosing in patients with renal impairment, as noted in various studies 2, 3, 4, 5. It is also crucial to remember that antibiotic therapy is an adjunct to the primary treatment of choledocolithiasis, which typically involves endoscopic retrograde cholangiopancreatography (ERCP) for stone removal and drainage. Given the potential for penicillin allergy overdiagnosis, as highlighted in studies 2, 4, 5, it is vital to carefully evaluate the allergy history and consider penicillin skin testing or alternative antibiotics when necessary. However, in the context of choledocolithiasis, the use of non-beta-lactam antibiotics like ciprofloxacin can be safe and effective, even in patients with reported penicillin allergy, as suggested by a study 2.