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Fever-based antibiotic therapy for acute cholangitis following successful endoscopic biliary drainage

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background

The current management of acute cholangitis consists of antibiotic therapy in combination with biliary drainage. However, the optimal duration of antibiotic therapy after the resolution of clinical symptoms by biliary drainage is unclear. We aimed to evaluate whether discontinuing antibiotic therapy for acute cholangitis immediately after the resolution of clinical symptoms, achieved by endoscopic biliary drainage, was safe and effective.

Methods

This prospective study included patients with moderate and severe acute cholangitis. Cefmetazole sodium and meropenem hydrate were used as initial antibiotic therapy for patients with moderate and severe acute cholangitis, respectively. All patients underwent endoscopic biliary drainage within 24 h of diagnosis. When the body temperature of <37°C was maintained for 24 h, administration of antibiotics was stopped. The primary endpoint was the recurrence of acute cholangitis within 3 days after the withdrawal of antibiotic therapy.

Results

Eighteen patients were subjected to the final analysis. The causes of cholangitis were bile duct stone (n = 17) and bile duct cancer (n = 1). The severity of acute cholangitis was moderate in 14 patients and severe in 4. Body temperature of <37°C was achieved in all patients after a median of 2 days (range 1–6) following endoscopic biliary drainage. Antibiotic therapy was administered for a median duration of 3 days (range 2–7). None of the patients developed recurrent cholangitis within 3 days after the withdrawal of antibiotics.

Conclusions

Fever-based antibiotic therapy for acute cholangitis is safe and effective when resolution of fever is achieved following endoscopic biliary drainage.

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Abbreviations

CRP:

C-reactive protein

CMZ:

Cefmetazole sodium

MEPM:

Meropenem hydrate

ERCP:

Endoscopic retrograde cholangiopancreatography

ENBD:

Endoscopic nasobiliary drainage

EST:

Endoscopic sphincterotomy

EPBD:

Endoscopic papillary balloon dilation

WBC:

White blood cell

SD:

Standard deviation

ASA:

American Society of Anesthesiologists

AZT:

Aztreonam

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Hirofumi Kogure, Takeshi Tsujino, Keisuke Yamamoto, Suguru Mizuno, Yoko Yashima, Hiroshi Yagioka, Kazumichi Kawakubo, Takashi Sasaki, Yousuke Nakai, Kenji Hirano, Naoki Sasahira, Hiroyuki Isayama, Minoru Tada, Takao Kawabe, Masao Omata & Kazuhiko Koike

  2. Department of Infectious Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Sohei Harada, Yasuo Ota & Kazuhiko Koike

Authors
  1. Hirofumi Kogure
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  2. Takeshi Tsujino
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  3. Keisuke Yamamoto
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  4. Suguru Mizuno
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  11. Naoki Sasahira
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  12. Hiroyuki Isayama
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  14. Takao Kawabe
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  15. Masao Omata
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  16. Sohei Harada
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  17. Yasuo Ota
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  18. Kazuhiko Koike
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Corresponding author

Correspondence to Hirofumi Kogure.

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Kogure, H., Tsujino, T., Yamamoto, K. et al. Fever-based antibiotic therapy for acute cholangitis following successful endoscopic biliary drainage. J Gastroenterol 46, 1411–1417 (2011). https://doi.org/10.1007/s00535-011-0451-5

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  • DOI: https://doi.org/10.1007/s00535-011-0451-5

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