title: Fever-based antibiotic therapy for acute cholangitis following successful endoscopic biliary drainage.
abstract: BACKGROUND
  The current management of acute cholangitis consists of antibiotic therapy in combination with biliary drainage. However, the optimal duration of antibiotic therapy after the resolution of clinical symptoms by biliary drainage is unclear. We aimed to evaluate whether discontinuing antibiotic therapy for acute cholangitis immediately after the resolution of clinical symptoms, achieved by endoscopic biliary drainage, was safe and effective.
  
  
  METHODS
  This prospective study included patients with moderate and severe acute cholangitis. Cefmetazole sodium and meropenem hydrate were used as initial antibiotic therapy for patients with moderate and severe acute cholangitis, respectively. All patients underwent endoscopic biliary drainage within 24 h of diagnosis. When the body temperature of < 37 ° C was maintained for 24 h, administration of antibiotics was stopped. The primary endpoint was the recurrence of acute cholangitis within 3 days after the withdrawal of antibiotic therapy.
  
  
  RESULTS
  Eighteen patients were subjected to the final analysis. The causes of cholangitis were bile duct stone (n = 17) and bile duct cancer (n = 1). The severity of acute cholangitis was moderate in 14 patients and severe in 4. Body temperature of < 37 ° C was achieved in all patients after a median of 2 days (range 1-6) following endoscopic biliary drainage. Antibiotic therapy was administered for a median duration of 3 days (range 2-7). None of the patients developed recurrent cholangitis within 3 days after the withdrawal of antibiotics.
  
  
  CONCLUSIONS
  Fever-based antibiotic therapy for acute cholangitis is safe and effective when resolution of fever is achieved following endoscopic biliary drainage.
authors.affiliation: Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. kogureh-tky@umin.ac.jp
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kogure
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tsujino
authors.forename: Keisuke
authors.initials: K
authors.lastname: Yamamoto
authors.forename: Suguru
authors.initials: S
authors.lastname: Mizuno
authors.forename: Yoko
authors.initials: Y
authors.lastname: Yashima
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yagioka
authors.forename: Kazumichi
authors.initials: K
authors.lastname: Kawakubo
authors.forename: Takashi
authors.initials: T
authors.lastname: Sasaki
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Nakai
authors.forename: Kenji
authors.initials: K
authors.lastname: Hirano
authors.forename: Naoki
authors.initials: N
authors.lastname: Sasahira
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Isayama
authors.forename: Minoru
authors.initials: M
authors.lastname: Tada
authors.forename: Takao
authors.initials: T
authors.lastname: Kawabe
authors.forename: Masao
authors.initials: M
authors.lastname: Omata
authors.forename: Sohei
authors.initials: S
authors.lastname: Harada
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Ota
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Koike
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015311:Cefmetazole / Q000627:therapeutic use; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D002761:Cholangitis / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D004322:Drainage / Q000379:methods; D005260:Female; D005334:Fever / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D008297:Male; D000077731:Meropenem; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012720:Severity of Illness Index; D013845:Thienamycins / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D013845:Thienamycins; D015311:Cefmetazole; D000077731:Meropenem