From the Guidelines
For the treatment of cholecystitis, empiric antibiotic therapy should cover enteric gram-negative organisms, enterococci, and anaerobes, with piperacillin-tazobactam being a recommended first-line option. The choice of antibiotic should be directed by local practice, considering bacterial sensitivities and the degree of liver and/or renal impairment 1. According to the most recent guidelines, the initially selected antibiotic should cover gram-negative and -positive bacteria, and a common first-line agent for mild episodes is an aminopenicillin/beta-lactamase inhibitor 1.
Some key points to consider when selecting an antibiotic regimen for cholecystitis include:
- Coverage of common biliary pathogens, including E. coli, Klebsiella, Enterococcus, and anaerobes like Bacteroides
- Consideration of local epidemiology, risk factors for multidrug-resistant bacteria, and severity of infection
- Use of piperacillin-tazobactam or third-generation cephalosporins with anaerobic coverage for more severe cases
- Potential addition of antibiotic coverage against gram-positive organisms, such as glycopeptide antibiotics or oxazolidine antibiotics, in patients with sepsis or those who do not quickly respond to antibiotic treatment 1.
The 2019 guidelines also suggest alternative regimens, including beta-lactam/beta-lactamase inhibitor combinations, cephalosporins-based regimens, carbapenem-based regimens, fluoroquinolone-based regimens, and glycylcycline-based regimens 1. However, the most recent guidelines from 2022 recommend saving fluoroquinolones for specific cases due to high resistance and unfavorable side effect profiles 1.
Antibiotic duration typically ranges from 4-7 days, depending on clinical response and whether cholecystectomy is performed, with longer courses needed for complicated infections or when surgery is delayed. Ultimately, antibiotic therapy should be tailored to the individual patient's needs and adjusted based on culture results when available, with definitive treatment usually involving cholecystectomy in addition to antibiotics.
From the FDA Drug Label
In patients who develop nausea during the infusion, the rate of infusion may be slowed. Table 1: Dosage of Imipenem and Cilastatin for Injection (I.V.) in Adult Patients with Creatinine Clearance Greater than or Equal to 90 mL/min Suspected or Proven Pathogen Susceptibility Dosage of Imipenem and Cilastatin for Injection (I.V.) If the infection is suspected or proven to be due to a susceptible bacterial species 500 mg every 6 hours OR 1,000 mg every 8 hours
The recommended antibiotics for the treatment of cholecystitis include imipenem.
- The dosage is 500 mg every 6 hours or 1,000 mg every 8 hours for susceptible bacterial species.
- For bacterial species with intermediate susceptibility, the dosage is 1,000 mg every 6 hours. However, it is essential to note that the provided drug labels do not explicitly mention cholecystitis as an indication for these antibiotics. Therefore, the use of these antibiotics for cholecystitis should be based on clinical judgment and consideration of the underlying cause of the infection. It is crucial to consult the latest clinical guidelines and expert recommendations for the treatment of cholecystitis. 2
From the Research
Antibiotics for Cholecystitis
- The choice of antibiotics for cholecystitis depends on the severity of the disease and the suspected or confirmed causative microorganisms 3, 4.
- For patients undergoing laparoscopic cholecystectomy for acute cholecystitis, peri-operative antibiotic agents are recommended 5.
- Empirical broad-spectrum antibiotic therapy should be prescribed according to the severity of the cholecystitis, an associated history of recent antibiotic therapy, and local bacterial susceptibility patterns 3.
- The most frequent microorganisms in acute cholecystitis are Escherichia, Enterococcus, Klebsiella, and Enterobacter, and antibiotic therapy should be adjusted based on the specific micro-organism(s) and the results of sensitivity testing 4.
Recommended Antibiotics
- Second-generation cephalosporin (cefotetan) is effective against Gram-negative microorganisms 4.
- Vancomycin and teicoplanin are effective against Enterococcus 4.
- Ureidopenicillins (mezlocillin or piperacillin) are effective as monotherapy in patients with acute cholecystitis or cholangitis of moderate clinical severity 6.
- Aminoglycosides should be used with caution and for a limited duration due to the risk of nephrotoxicity 6.