Antibiotic use in acute cholecystitis: practice patterns in the absence of evidence-based guidelines.
OBJECTIVE
Antibiotics are frequently administered in acute cholecystitis for preoperative prophylaxis or postoperative treatment. The optimal timing, choice, and duration of antibiotics are unclear.


METHODS
We conducted a retrospective review of all cases of acute cholecystitis between 1996 and 2001 at the American University of Beirut Medical Centre. A survey among general surgeons was also performed to describe the pattern of antibiotic prescribing in uncomplicated acute cholecystitis. A MEDLINE search for guidelines for antibiotic use in acute cholecystitis was conducted.


RESULTS
The number of cases of acute cholecystitis was 79. The mean duration of postoperative antibiotic therapy was 5 days. There was no correlation between the severity of symptoms, gallbladder description, or positive gallbladder culture and the use of antibiotics postoperatively. Sixty five percent of interviewed surgeons would continue antibiotic therapy postoperatively for 3 or more days. Search of the medical literature failed to provide clear guidelines for antibiotic use in acute cholecystitis.


CONCLUSIONS
The use of antibiotics in patients with acute cholecystitis is erratic and costly. Prospective studies are needed to better study the effectiveness of a short course of antibiotics in uncomplicated cases. The role of gallbladder culture in guiding antibiotic therapy should be defined as routine cultures add to the cost without evident benefit.
Kanafani
Zeina A
ZA
Division of Infectious Diseases, American University of Beirut Medical Center, P.O. Box 11-0236, Riad El Solh 110 72020 Beirut, Lebanon.
Khalifé
Nadine
N
Kanj
Souha S
SS
Araj
George F
GF
Khalifeh
Mohammad
M
Sharara
Ala I
AI
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002763:Cholecystectomy; D041881:Cholecystitis, Acute / Q000188:drug therapy* / Q000382:microbiology* / Q000601:surgery; D016983:Enterococcus / Q000302:isolation & purification; D004926:Escherichia coli / Q000302:isolation & purification; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007861:Lebanon; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D011795:Surveys and Questionnaires
D000900:Anti-Bacterial Agents