Antibacterial Therapy of Acute Cholecystitis and Cholangitis (According to Tokyo Guidelines2013)

Yu.M. Stepanov, I.Yu. Skyrda, V.M. Hladun


Gallstone disease and inflammatory diseases of the biliary tract is a serious problem in health protection in developed countries. Acute cholecystitis is the third major cause of the urgent hospitalization to the surgical department, and its incidence increases with age. Acute cholecystitis is defined as an acute inflammation of the gallbladder, which is often observed in the presence of gallstones. There are a variety of methods for acute cholecystitis treatment in different medical centers around the world. In some hospitals, mainly in the USA, the most common method of treatment is early laparoscopic cholecystectomy within 72 hours from the onset of symptoms or hospitalization. However, the treatment of acute cholecystitis is conservative (bowel rest, intravenous administration of fluids and antibiotics) in the UK and many other European countries, laparoscopic cholecystectomy is delayed in this case. The causes of delayed surgery are different between institutions and are based on the assumption about the reduction of complications during surgery, information about available beds and surgery schedule, costs and hospital policy. Over the years this approach has shown a relatively low rate of complications, mainly those related to bile duct injury, — < 1 %. But current approaches based on the principles of evidence-based medicine have proven the safety and effectiveness of early laparoscopic cholecystectomy that is the similar to delayed one.
In the last five years, there were developed several guidelines on the management of infection of the biliary tract. They include the Surviving Sepsis Campaign, 2008, and recommendations for the treatment of complicated intraabdominal infections, that have been developed by Surgical Infection Society of North America, and the Infectious Diseases Society of America, 2010. In addition, new drugs and dosing regimens have been approved, including schemes with higher doses for piperacillin/tazobactam, meropenem, levofloxacin and doribax. The issues of pharmacokinetics and pharmacodynamics of antibacterial drugs have been clarified. Since the release of Tokyo Guidelines 2007, the emergence of antibacterial resistance among clinical strains of enterobacteria in patients with community-acquired intraabdominal infection has been reported, and it led to the appearance of extended spectrum beta-lactamase and carbapenems. Finally, the updated Tokyo Guidelines 2013 revised the diagnostic criteria and severity of acute cholecystitis and cholangitis according to the new pattern of antibiotic therapy.
Antibiotics should be used wisely in antimicrobial therapy in each institution, region and country. The recent global spread of antibiotic resistance gives us a warning in the modern practice. Tokyo Guidelines 2013 provide practical guidance for physicians and surgeons involved in the treatment of community-acquired and hospital acute biliary infection. Much remains uncertain in this view. Continuous monitoring of local resistance to antibiotics and further studies in acute cholecystitis and cholangitis should be justified.


Малоінвазійне лікування хворих на гострий холецистит, ускладнений перитонітом і холангітом / Павловський М.П., Коломійцев В.І., Гавриш Я.І., Шахова Т.І. // Український журнал хірургії. — 2011. — № 4(13). — С. 33-37.

Keus F. Open, small-incision, or laparoscopic cholecystectomy for patients with symptomatic cholecystolithiasis. An overview of Cochrane Hepato-Biliary Group reviews / F. Keus, H.G. Gooszen, C.J.H.M. van Laarhoven // Cochrane Database of Systematic Reviews. — 2009. — № 4. — P. 134.

Evaluation of compliance with the Tokyo Guidelines for the management of acute cholangitis based on the Japanese administrative database associated with the Diagnosis Procedure Combination system / A. Murata, S. Matsuda, K. Kuwabara et al. // J. Hepatobiliary Pancreat. Sci. — 2010. — Vol. 18. — P. 53-59.

Жидков С.А. Тактика лечения острого холецистита у пациентов старше 60 лет / С.А. Жидков // Медицинские новости. — 2005. — № 7. — С. 68-70.

Проблема хирургического лечения гнойного холангита у больных острым осложненным калькулезным холециститом / Воротынцев А.С., Кириллин А.В., Меграбян Р.А., Ханин А.Г. // Курский научно-практический вестник «Человек и его здоровье». — 2007. — № 4. — С. 75-80.

Столин А.В. Значение признаков системного воспалительного ответа в диагностике и лечении гнойного холангита / А.В. Столин, Е.В. Нишневич, М.И. Прудков // Анналы хирургической гепатологии. — 2009. — № 2. — С. 16.

Role of antibiotics in the treatment and prevention of acute and recurrent cholangitis / S.J. vanden Hazel, P. Speelman, G.N.J. Tytgat et al. // Clin. Infect. Dis. — 1994. — Vol. 19. — P. 279-286.

Beoy J.H. Acute cholangitis / J.H. Beoy, L.W. Way // Ann. Surg. — 1980. — Vol. 191. — P. 264-270.

Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008 / R.P. Dellinger, M.M. Levy, J.M. Carlet et al. // Crit. Care Med. — 2008. — Vol. 36. — P. 296-327.

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 / J.S. Solomkin, J.E. Mazuski, J.S. Bradley et al. // Clin. Infect. Dis. — 2010. — Vol. 50. — P. 133-164.

Antimicrobial therapy for acute cholangitis: Tokyo Guidelines / A. Tanaka, T. Takada, Y. Kawarada et al. // J. Hepatobiliary Pancreat. Surg. — 2007. — Vol. 14. — P. 59-67.

Antimicrobial susceptibility profiles of aerobic and facul-tative Gram-negative bacilli isolated from patients with intra-abdominal infections in the Asia-Pacific region according to currently established susceptibility interpretive criteria / Y.H. Chen, P.R. Hsueh, R.E. Badal et al. // J. Infect. — 2011. — Vol. 62. — P. 280-291.

Clinical features and outcome of community-onset bloodstream infections caused by extended-spectrum ß-lactamase-producing Escherichia coli / C.I. Kang, H. Cheong, D. Chung et al. // Eur. J. Clin. Microb. Infect. Dis. — 2008. — Vol. 27. — P. 85-88.

Molecular epidemiology over an 11-year period (2000 to 2010) of extended-spectrum ß-lactamase-producing Escherichia coli causing bacteremia in a centralized Canadian region / Peirano G., van der Bij A.K., Gregson D.B., Pitout J.D.D. // J. Clin. Microbiol. — 2012. — Vol. 50. — P. 294-299.

The clinical epidemiology and outcomes of bacteremic biliary tract infections caused by antimicrobial-resistant pathogens / Y.K. Sung, J.K. Lee, K.H. Lee et al. // Am. J. Gastroenterol. — 2012. — Vol. 107. — P. 473-483.

Salvador V. Microbiology and antibiotic susceptibility of organisms in bile cultures from patients with and without cholangitis at an Asian Academic Medical Center / V. Salvador, M. Lozada, R. Consunji // Surg. Infect. — 2011. — Vol. 12. — P. 105-111.

Biliary tract infection and bacteremia: presentation, structural abnormalities, causative organisms and clinical outcomes / M. Melzer, R. Toner, S. Lacey et al. // Postgrad. Med. J. — 2007. — Vol. 83. — P. 773-776.

Epidemiology and prognostic determinants of patients with bacteremic cholecystitis or cholangitis / C.C. Lee, I.J. Chang, Y.C. Lai et al. // Am. J. Gastroenterol. — 2007. — Vol. 102. — P. 563-569.

Prevalenciae fatores associados a bacteremia nos portadores de colecistite aguda litiaґsica / Baitello A.L., Colleoni Neto R., Herani Filho B. et al. // Revistada Associacёao Meґdica Brasileira. — 2004. — Vol. 50. — P. 373-379.

Antimicrobial management of intra-abdominal infections: Literature’s guidelines / Massimo Sartelli, Fausto Catena, Federico Coccolini, and Antonio Daniele Pinna World // J. Gastroenterol. — 2012. — Vol. 18(9). — P. 865-871.

Goodman and Gilman’s the pharmacological basis of the-rapeutics / Еd. by Brunton L.L., Chabner B.A., Knollman B.C. — 12th ed. — New York: The McGraw-Hill Companies, 2011.

McKenzie C. Antibiotic dosing in critical illness / C. McKenzie // J. Antimicrob. Chemother. — 2011. — Vol. 66 (suppl. 2). — P. 25-31.

Randomized controlled trial of moxifloxacin compared with piperacillin-tazobactam and amoxicillin-clavulanate for the treatment of complicated intra-abdominal infections / M.A. Malangoni, J. Song, J. Herrington et al. // Ann. Surg. — 2006. — Vol. 244. — P. 204-211.

Schultsz C. Plasmid-mediated resistance in Entero-bacteriaceae: changing landscape and implications for therapy / C. Schultsz, S. Geerlings // Drugs. — 2012. — Vol. 72. — P. 1-16.

Excess deaths associated with tigecycline after approval based on non-inferiority trials / Prasad P., Sun J., Danner R.L., Natanson C. // Clin. Infect. Dis. — 2012. — Vol. 54. — P. 1699-1709.

Colistin-resistant, Klebsiella pneu-moniae carbapenemase (KPC)-producing Klebsiella pneumoniae belonging to the international epidemic clone ST258 / T. Bogdanovich, J.M. Adams-Haduch, G.B. Tian et al. // Clin. Infect. Dis. — 2011. — Vol. 53. — P. 373-376.

Brand M. Antibiotic prophylaxis for patients undergoing elective endoscopic retrograde cholangio-pancreatography (review) / M. Brand, D. Bizs, P.J.R. O’Farrell // Cochrane Database Syst. Rev. — 2010, Oct 6. — (10). — CD007345.

Guidelines for antibiotic prophylaxis for GI endoscopy / W.K. Hirota, K. Petersen, T.H. Baron et al. // Gastrointest. Endosc. — 2003. — Vol. 58. — P. 475-482. (CPGs)

Prophylactic antibiotics cannot prevent endoscopic retrograde cholangiopancreatography-induced cholangitis: meta-analysis / Y. Bai, F. Gao, J. Gao et al. // Pancreas. — 2009. — Vol. 38. — P. 126-130.

Alexander J.W. Updated recommendations for control of surgical site infections / J.W. Alexander, J.S. Solomkin, M.J. Edwards // Ann. Surg. — 2011. — Vol. 253. — P. 1082-1093. (CPGs)



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