title: Early oral antibiotic switch compared with conventional intravenous antibiotic therapy for acute cholangitis with bacteremia.
abstract: BACKGROUND
  Biliary decompression with antibiotic therapy is the mainstay treatment for acute cholangitis with bacteremia. A few studies have been conducted to investigate the optimal duration and route of antibiotic therapy in biliary tract infection with bacteremia.
  
  
  METHODS
  Patients with acute cholangitis with bacteremia who achieved successful biliary drainage were randomly assigned to an early oral antibiotic switch group (group A, n = 29) and a conventional intravenous antibiotics group (group B, n = 30). Patients were discharged when they were afebrile over 2 days after oral antibiotic switch and showed consecutive improvement in the laboratory index. They were followed up and assessed at 30 days after diagnosis to evaluate the eradication of bacteria, recurrence of acute cholangitis, and 30-day mortality rate.
  
  
  RESULTS
  There were no statistically significant differences between the two groups in baseline characteristics, clinical and laboratory index, severity of acute cholangitis, bacteria isolated from blood cultures, and clinical outcomes. The rate of eradication of bacteria was 93.1 % in group A and 93.3 % in group B, respectively (p = 0.97). Using non-inferiority tests, the rate of eradication of bacteria in group A was not inferior to that in group B (95 % CI -0.13 to 0.14, p = 0.97). There was no statistically significant difference in the recurrence of acute cholangitis and a 30-day mortality rate between the two groups.
  
  
  CONCLUSIONS
  Early switch to oral antibiotic therapy following adequate biliary drainage for treatment of acute cholangitis with bacteremia was not inferior to conventional 10-day intravenous antibiotic therapy.
authors.affiliation: Division of Gastroenterology, Chung-Ang University College of Medicine, Heukseok-ro 102, Dongjak-gu, Seoul, Korea.
authors.forename: Tae Young
authors.initials: TY
authors.lastname: Park
authors.forename: Jung Sik
authors.initials: JS
authors.lastname: Choi
authors.forename: Tae Jun
authors.initials: TJ
authors.lastname: Song
authors.forename: Jae Hyuk
authors.initials: JH
authors.lastname: Do
authors.forename: Seong-Ho
authors.initials: SH
authors.lastname: Choi
authors.forename: Hyoung-Chul
authors.initials: HC
authors.lastname: Oh
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D016470:Bacteremia / Q000150:complications / Q000188:drug therapy*; D002761:Cholangitis / Q000150:complications*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D000900:Anti-Bacterial Agents