From the Research
For acute cholecystitis, the recommended antibiotic regimen is piperacillin-tazobactam 3.375g IV every 6 hours or 4.5g IV every 8 hours, as supported by the most recent and highest quality study 1. The choice of antibiotic is crucial in the management of acute cholecystitis, as it helps to prevent surgical complications and limit the systemic inflammatory response.
- The most frequently isolated microorganisms in acute cholecystitis are Escherichia coli, Klebsiella spp., Streptococcus spp., Enterococcus spp., and Clostridium spp.
- Early empirical antimicrobial therapy along with source control of infection is the cornerstone for a successful treatment, as stated in 1.
- Alternative options include ceftriaxone 1-2g IV daily plus metronidazole 500mg IV every 8 hours, or ciprofloxacin 400mg IV every 12 hours plus metronidazole if fluoroquinolones are necessary.
- For patients with severe penicillin allergies, aztreonam 2g IV every 8 hours plus metronidazole can be used.
- Treatment duration should typically be 4-7 days, with longer courses for complicated infections or persistent symptoms, as recommended in 2.
- The definitive treatment for acute cholecystitis is usually cholecystectomy, with antibiotics serving as an important adjunctive therapy to control infection and prevent complications, as supported by 3.
- It is essential to be aware of the appropriate therapeutic scheme and its precise duration, and to integrate antibiotic stewardship into good clinical practice and standards of care, as emphasized in 1.