title: Antimicrobial therapy for acute cholecystitis: Tokyo Guidelines.
abstract: Acute cholecystitis consists of various morbid conditions, ranging from mild cases that are relieved by the oral administration of antimicrobial drugs or that resolve even without antimicrobials to severe cases complicated by biliary peritonitis. Microbial cultures should be performed by collecting bile at all available opportunities to identify both aerobic and anaerobic organisms. Empirically selected antimicrobials should be administered. Antimicrobial activity against potential causative organisms, the severity of the cholecystitis, the patient's past history of antimicrobial therapy, and local susceptibility patterns (antibiogram) must be taken into consideration in the choice of antimicrobial drugs. In mild cases which closely mimic biliary colic, the administration of nonsteroidal anti-inflammatory drugs (NSAIDs) is recommended to prevent the progression of inflammation (recommendation grade A). When causative organisms are identified, the antimicrobial drug should be changed for a narrower-spectrum antimicrobial agent on the basis of the species and their susceptibility testing results.
authors.affiliation: Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yoshida
authors.forename: Tadahiro
authors.initials: T
authors.lastname: Takada
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Kawarada
authors.forename: Atsushi
authors.initials: A
authors.lastname: Tanaka
authors.forename: Yuji
authors.initials: Y
authors.lastname: Nimura
authors.forename: Harumi
authors.initials: H
authors.lastname: Gomi
authors.forename: Masahiko
authors.initials: M
authors.lastname: Hirota
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Miura
authors.forename: Keita
authors.initials: K
authors.lastname: Wada
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Mayumi
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Solomkin
authors.forename: Steven
authors.initials: S
authors.lastname: Strasberg
authors.forename: Henry A
authors.initials: HA
authors.lastname: Pitt
authors.forename: Jacques
authors.initials: J
authors.lastname: Belghiti
authors.forename: Eduardo
authors.initials: E
authors.lastname: de Santibanes
authors.forename: Sheung-Tat
authors.initials: ST
authors.lastname: Fan
authors.forename: Miin-Fu
authors.initials: MF
authors.lastname: Chen
authors.forename: Giulio
authors.initials: G
authors.lastname: Belli
authors.forename: Serafin C
authors.initials: SC
authors.lastname: Hilvano
authors.forename: Sun-Whe
authors.initials: SW
authors.lastname: Kim
authors.forename: Chen-Guo
authors.initials: CG
authors.lastname: Ker
mesh_terms: D000890:Anti-Infective Agents / Q000493:pharmacokinetics / Q000627:therapeutic use*; D041881:Cholecystitis, Acute / Q000188:drug therapy*; D005704:Gallbladder / Q000187:drug effects / Q000382:microbiology; D006801:Humans; D014041:Tokyo
chemical_list: D000890:Anti-Infective Agents