[Ceftriaxone versus Levofloxacin for antibiotic therapy in patients with acute cholangitis].
BACKGROUND
For the therapy of acute cholangitis complete biliary drainage and antibiotic therapy is needed. The aim of the current study was to compare intravenous therapy of acute cholangitis with Ceftriaxone or Levofloxacin in a prospective and randomized fashion.


METHODS
Patients with biliary obstruction and clinical signs of infection received in addition to 1.5 g Metronidazole either 500 mg Levofloxacin/die or 2 g Ceftriaxone/die. Early on during ERCP, bile was aspirated via the cannulation catheter and cultured for bacteria under aerobic and anaerobic conditions. Minimal inhibitory concentrations of the respective antibiotics were determinate for each isolate. The clinical course was followed for at least 6 days with clinical and laboratory data.


RESULTS
60 patients with clinical signs of acute cholangitis were randomised. In 40 patients (66 %) biliary colonization with bacteria could be identified. In all bacterial species Levofloxacin showed significantly lower rates of in-vitro resistance as compared to Ceftriaxone. However, the percentage of patients with a clinical cure or significant improvement was the same in the two groups.


CONCLUSIONS
The clinical effect of Levofloxacin and Ceftriaxone in patients with acute cholangitis showed no significant differences. Because of improved in-vitro efficiency, a calculated therapy with Levofloxacin might be advantageous.
Kiesslich
R
R
I. Med. Klinik und Poliklinik, Johannes-Gutenberg-Universität, Mainz. Kiesslic@mail.uni-mainz.de
Will
D
D
Hahn
M
M
Nafe
B
B
Genitsariotis
R
R
Mäurer
M
M
Jung
M
M
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D001419:Bacteria / Q000187:drug effects / Q000302:isolation & purification; D001431:Bacteriological Techniques; D001646:Bile / Q000382:microbiology; D002443:Ceftriaxone / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002761:Cholangitis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000382:microbiology; D003627:Data Interpretation, Statistical; D024881:Drug Resistance, Bacterial; D006801:Humans; D007262:Infusions, Intravenous; D064704:Levofloxacin; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D015242:Ofloxacin / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D011446:Prospective Studies; D013997:Time Factors
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D008795:Metronidazole; D064704:Levofloxacin; D002443:Ceftriaxone; D015242:Ofloxacin