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 it is effective against the common pathogens in biliary infections, including Enterobacteriaceae, Enterococcus species, and anaerobes 1. The choice of antibiotic should consider the severity of the clinical manifestations, the onset of the infection, and any drug resistance.
- 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 must be used.
- For patients with severe penicillin allergies, aztreonam 2g IV every 8 hours plus metronidazole is appropriate.
- Antibiotic therapy should typically continue for 4-7 days, though shorter courses may be sufficient if source control is achieved through cholecystectomy.
- The empirical use of first-generation cephalosporins for mild-to-moderate acute cholecystitis without gallbladder perforation was not inferior to using second-generation cephalosporin for prophylaxis against postoperative infection 2.
- In moderate acute cholecystitis after percutaneous cholecystostomy, patients receiving narrow-spectrum antibiotics have comparable clinical outcomes as those treated with broad-spectrum antibiotics 3.
- However, in severe acute cholecystitis, broad-spectrum antibiotics might still be necessary to rescue these patients. The most recent and highest quality study 1 supports the use of piperacillin-tazobactam as the first-line antibiotic regimen for acute cholecystitis, and it is essential to start antibiotic therapy promptly after diagnosis while arranging for definitive treatment, which is usually cholecystectomy.