Antimicrobial therapy for acute cholecystitis: Tokyo Guidelines.
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.
Yoshida
Masahiro
M
Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan.
Takada
Tadahiro
T
Kawarada
Yoshifumi
Y
Tanaka
Atsushi
A
Nimura
Yuji
Y
Gomi
Harumi
H
Hirota
Masahiko
M
Miura
Fumihiko
F
Wada
Keita
K
Mayumi
Toshihiko
T
Solomkin
Joseph S
JS
Strasberg
Steven
S
Pitt
Henry A
HA
Belghiti
Jacques
J
de Santibanes
Eduardo
E
Fan
Sheung-Tat
ST
Chen
Miin-Fu
MF
Belli
Giulio
G
Hilvano
Serafin C
SC
Kim
Sun-Whe
SW
Ker
Chen-Guo
CG
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
D000890:Anti-Infective Agents