Overlay

Cholecystitis Empiric Therapy 

Cholecystitis Empiric Therapy 

No Results

No Results

processing….

Empiric antibiotic regimens for cholecystitis are outlined below, divided by those for community-acquired acute cholecystitis as categorized by severity of illness, and healthcare–associated cholecystitis of any severity. [1, 2, 3, 4, 5] Consideration of local antibiograms is highly suggested, where available.

Disease of mild-to-moderate severity

Mild severity:Healthy patient, no organ dysfunction, mild inflammatory changes of gallbladder

Moderate severity:White blood cell (WBC) count above 18,000 cells/mm3, duration of symptoms longer than 72 hours, palpable tender mass in the right upper quadrant, marked local inflammation on imaging studies

Cefazolin 1-2 g IV q8h or

Cefuroxime 1.5 g IV q8h or

Ceftriaxone 1-2 g IV daily

Disease of high severity*

High severity: Patients with organ dysfunction or immunocompromised state 

Imipenem-cilastatin 500 mg IV q6h or

Ertapenem 1 g IV q24h or

Meropenem 1 g IV q8h or

Doripenem 500 mg IV q8h or

Piperacillin-tazobactam 3.375 g IV q6h or

Cefepime 2 g IV q8-12h plus  metronidazole 500 mg IV q8h or

Ciprofloxacin** 400 mg IV q12h plus  metronidazole 500 mg IV q8h or

Levofloxacin** 750 mg IV q24h plus  metronidazole 500 mg IV q8h or

*Consider the addition of vancomycin 15-20 mg/kg IV q12h to the above regimens for enterococcal coverage.

**Due to the increasing resistance of E coli to fluoroquinolones, local susceptibility profiles should be reviewed before empiric use.

Pseudomonal and enterococcal coverage is recommended. Recommended regimens include:

Imipenem-cilastatin 250-500 mg IV q6-8h plus vancomycin 15-20 mg/kg IV q12h or

Ertapenem 1 g IV daily plus  vancomycin 15-20 mg/kg IV q12h or

Meropenem 0.5-1 g IV q8h plus  vancomycin 15-20 mg/kg IV q12h or

Doripenem 500 mg IV q8h plus  vancomycin 15-20 mg/kg IV q12h or

Piperacillin-tazobactam 3.375 g IV q6h plus  vancomycin 15-20 mg/kg IV q12h or

Cefepime 2 g IV q8-12h plus  metronidazole 500 mg IV q8h plus  vancomycin 15-20 mg/kg IV q12h or

Ciprofloxacin** 400 mg IV q12h plus  metronidazole 500 mg IV q8h plus  vancomycin 15-20 mg/kg IV q12h or

Levofloxacin** 750 mg IV daily plus  metronidazole 500 mg IV q8h plus vancomycin 15-20 mg/kg IV q12h 

**Due to the increasing resistance of E coli to fluoroquinolones, local susceptibility profiles should be reviewed before empiric use.

The duration of empiric cholecystitis antibiotic therapy should be guided by severity and clinical improvement, as follows:

Solomkin JS, Mazuski JE, Bradley JS, et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Surg Infect (Larchmt). 2010 Feb. 11(1):79-109. [Medline].

Hoffmann C, Zak M, Avery L, Brown J. Treatment modalities and antimicrobial stewardship initiatives in the management of intra-abdominal infections. Antibiotics (Basel). 2016 Feb 15. 5 (1):[Medline].

[Guideline] Gomi H, Solomkin JS, Takada T, et al, for the Tokyo Guideline Revision Committee. TG13 antimicrobial therapy for acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2013 Jan. 20 (1):60-70. [Medline].

[Guideline] Takada T, Strasberg SM, Solomkin JS, et al, for the Tokyo Guidelines Revision Committee. TG13: Updated Tokyo Guidelines for the management of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2013 Jan. 20 (1):1-7. [Medline].

[Guideline] Yokoe M, Takada T, Strasberg SM, et al, for the Tokyo Guidelines Revision Committee. TG13 diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci. 2013 Jan. 20 (1):35-46. [Medline].

David M Faleck, MD Fellow, Department of Gastroenterology, Icahn School of Medicine at Mount Sinai

David M Faleck, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Gastroenterology, American Gastroenterological Association, American Medical Association, New York Society for Gastrointestinal Endoscopy, Phi Beta Kappa

Disclosure: Nothing to disclose.

David Greenwald, MD Professor of Clinical Medicine, Fellowship Program Director, Department of Medicine, Division of Gastroenterology, Montefiore Medical Center, Albert Einstein College of Medicine

David Greenwald, MD is a member of the following medical societies: Alpha Omega Alpha, New York Society for Gastrointestinal Endoscopy, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Thomas E Herchline, MD Professor of Medicine, Wright State University, Boonshoft School of Medicine; Medical Consultant, Public Health, Dayton and Montgomery County (Ohio) Tuberculosis Clinic

Thomas E Herchline, MD is a member of the following medical societies: Alpha Omega Alpha, Infectious Diseases Society of America, Infectious Diseases Society of Ohio

Disclosure: Nothing to disclose.

Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR Consultant Radiologist and Honorary Professor, North Manchester General Hospital Pennine Acute NHS Trust, UK

Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR is a member of the following medical societies: American Association for the Advancement of Science, American Institute of Ultrasound in Medicine, British Medical Association, Royal College of Physicians and Surgeons of the United States, British Society of Interventional Radiology, Royal College of Physicians, Royal College of Radiologists, Royal College of Surgeons of England

Disclosure: Nothing to disclose.

Cholecystitis Empiric Therapy 

Research & References of Cholecystitis Empiric Therapy |A&C Accounting And Tax Services
Source

5 thoughts on “Cholecystitis Empiric Therapy 

  1. Pingback: generic viagra
  2. Pingback: cost of viagra
  3. Pingback: sildenafil 20 mg

Leave a Reply