What are the oral antibiotics for Cholangitis?

From the Guidelines

For oral antibiotics in cholangitis, ciprofloxacin 500 mg twice daily is recommended as a first-line agent for mild episodes, as directed by local practice and considering the history, severity of liver or renal disease, and bacterial sensitivities 1. When choosing an oral antibiotic regimen, it's essential to consider the common causative organisms, including Escherichia coli, Klebsiella, Enterococcus, and anaerobes.

• The selection of antibiotics should include those with a broad range of antimicrobial activity with good penetration into the bile ducts, such as fluoroquinolones 1.
• Oral therapy should only be initiated after fever resolves, pain decreases, and laboratory values improve, and patients should complete the full course even if symptoms resolve quickly.
• It's crucial to ensure biliary drainage has been established through ERCP or percutaneous methods before transitioning to oral antibiotics, as patients with severe acute cholangitis and dominant bile duct strictures require urgent biliary decompression 1.
• Patients should be monitored for clinical deterioration and advised to seek immediate medical attention if fever returns, pain worsens, or jaundice deepens, as these may indicate treatment failure requiring hospitalization and intravenous antibiotics. The use of antibiotics in cholangitis is critical, and the choice of agent should be guided by local practice and the severity of the disease, with a focus on targeting the common causative organisms and ensuring adequate biliary drainage 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Oral Antibiotics for Cholangitis

• The use of oral antibiotics for cholangitis is supported by several studies, including one that compared the efficacy and safety of oral ciprofloxacin and intravenous cefuroxime in patients at high risk of cholangitis after endoscopic retrograde cholangiopancreatography (ERCP) 2.
• This study found that oral ciprofloxacin was safe and provided effective prophylaxis against ERCP-induced cholangitis and septicaemia in high-risk patients, and was also more economical than intravenous cefuroxime.
• Another study discussed the management of acute cholangitis, including the use of antibiotic therapy, and noted that bacterial infections are the most common cause of acute cholangitis 3.
• The Tokyo Guidelines 2018 provide recommendations for the use of antimicrobials in the management of acute cholangitis and cholecystitis, including the use of oral antibiotics in certain cases 4.
• A study comparing cefmetazole with carbapenems and piperacillin/tazobactam as initial therapy for bacteremic acute cholangitis found that cefmetazole may be an alternative to carbapenems and piperacillin/tazobactam, with a shorter length of stay and lower antibiotic costs 5.

Types of Oral Antibiotics

• Ciprofloxacin is one type of oral antibiotic that has been studied for use in cholangitis, and has been found to be effective in preventing ERCP-induced cholangitis and septicaemia 2.
• Cefmetazole is another type of oral antibiotic that has been compared to carbapenems and piperacillin/tazobactam as initial therapy for bacteremic acute cholangitis, and may be a useful alternative in certain cases 5.

Considerations for Use

• The use of oral antibiotics for cholangitis should be guided by the severity of the infection, the presence of any underlying conditions, and the potential for antibiotic resistance 4.
• The Tokyo Guidelines 2018 recommend monitoring and updating local antibiograms, and prudent antimicrobial usage and early de-escalation or termination of antimicrobial therapy 4.