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Review of the Tokyo Guidelines 2018: Antimicrobial Therapy for Acute Cholangitis and Cholecystitis

Educational Objective To state the antimicrobial guidelines for therapy for acute cholangitis and cholecystitis.
1 Credit CME

Timely treatment of acute cholecystitis and cholangitis is necessary to prevent unwanted outcomes. Quiz Ref IDThe most important aspect of treatment is source control, but antimicrobial treatment is a necessary and important adjunct. The primary goal of antimicrobial therapy is to limit the systemic septic response and local inflammation and prevent surgical site infection and intrahepatic abscess formation.1 Increasing antimicrobial resistance, particularly owing to extended-spectrum β-lactamase (ESBL)–producing Enterobacteriaceae, complicates selection of anti-infective agents, making knowledge of local epidemiological data important. Provision of antimicrobial therapy calls for a balance between ensuring adequate treatment of the pathogen(s) and minimizing risk of collateral damage due to excessive antimicrobial administration. Stratifying antimicrobial use based on severity of infection and whether it is a community-acquired or health care–associated infection, deescalating therapy once definitive culture results are available, and limiting duration of therapy when appropriate promote optimal antimicrobial use.

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Article Information

Corresponding Author: John E. Mazuski, MD, PhD, Department of Surgery, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8109, St Louis, MO 63110-1093 (mazuskij@wustl.edu).

Published Online: July 3, 2019. doi:10.1001/jamasurg.2019.2169

Conflict of Interest Disclosures: Dr Mazuski has received personal fees from Allergan, Bayer Pharmaceuticals, GlaxoSmithKline, Melinta Therapeutics, Pfizer Pharmaceuticals, and Tetraphase Pharmaceuticals as well as grants and personal fees from Merck & Co; served as President of the Surgical Infection Society, task force leader, and first author of the 2017 Surgical Infection Society revised guidelines for the treatment of intra-abdominal infection; and was a coauthor of the 2015 Surgical Infection Society Study to Optimize Peritoneal Infection Therapy trial, the 2017 World Society of Emergency Surgery guidelines on intra-abdominal infection, the revised Surviving Sepsis guidelines published in 2017, and the 2017 US Centers for Disease Control and Prevention guideline for the prevention of surgical site infection. No other disclosures were reported.

References
1.
van den Hazel  SJ, Speelman  P, Tytgat  GNJ, Dankert  J, van Leeuwen  DJ.  Role of antibiotics in the treatment and prevention of acute and recurrent cholangitis.  Clin Infect Dis. 1994;19(2):279-286. doi:10.1093/clinids/19.2.279PubMedGoogle ScholarCrossref
2.
Paterson  DL.  Resistance in gram-negative bacteria: Enterobacteriaceae.  Am J Infect Control. 2006;34(5, suppl 1):S20-S28, S64-S73.PubMedGoogle ScholarCrossref
3.
Rhodes  A, Evans  LE, Alhazzani  W,  et al.  Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016.  Intensive Care Med. 2017;43(3):304-377.PubMedGoogle ScholarCrossref
4.
Giuliano  CA, Patel  CR, Kale-Pradhan  PB.  Is the combination of piperacillin-tazobactam and vancomycin associated with development of acute kidney injury?  Pharmacotherapy. 2016;36(12):1217-1228.PubMedGoogle ScholarCrossref
5.
Harris  PNA, Tambyah  PA, Lye  DC,  et al; MERINO Trial Investigators and the Australasian Society for Infectious Disease Clinical Research Network (ASID-CRN).  Effect of piperacillin-tazobactam vs meropenem on 30-day mortality for patients with E coli or Klebsiella pneumoniae bloodstream infection and ceftriaxone resistance.  JAMA. 2018;320(10):984-994.PubMedGoogle ScholarCrossref
6.
Kim  EY, Yoon  YC, Choi  HJ, Kim  KH, Park  JH, Hong  TH.  Is there a real role of postoperative antibiotic administration for mildmoderate acute cholecystitis?  J Hepatobiliary Pancreat Sci. 2017;24(10):550-558.PubMedGoogle ScholarCrossref
7.
Sawyer  RG, Claridge  JA, Nathens  AB,  et al; STOP-IT Trial Investigators.  Trial of short-course antimicrobial therapy for intraabdominal infection.  N Engl J Med. 2015;372(21):1996-2005.PubMedGoogle ScholarCrossref
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