Fever-based antibiotic therapy for acute cholangitis following successful endoscopic biliary drainage

被引：35

作者：

Kogure, Hirofumi ^{[1
]}

Tsujino, Takeshi ^{[1
]}

Yamamoto, Keisuke ^{[1
]}

Mizuno, Suguru ^{[1
]}

Yashima, Yoko ^{[1
]}

Yagioka, Hiroshi ^{[1
]}

Kawakubo, Kazumichi ^{[1
]}

Sasaki, Takashi ^{[1
]}

Nakai, Yousuke ^{[1
]}

Hirano, Kenji ^{[1
]}

Sasahira, Naoki ^{[1
]}

Isayama, Hiroyuki ^{[1
]}

Tada, Minoru ^{[1
]}

Kawabe, Takao ^{[1
]}

Omata, Masao ^{[1
]}

Harada, Sohei ^{[2
]}

Ota, Yasuo ^{[2
]}

Koike, Kazuhiko ^{[1
,2
]}

机构：

[1] Univ Tokyo, Grad Sch Med, Dept Gastroenterol, Bunkyo Ku, Tokyo 1138655, Japan

[2] Univ Tokyo, Grad Sch Med, Dept Infect Dis, Tokyo 1138655, Japan

来源：

JOURNAL OF GASTROENTEROLOGY | 2011年 / 46卷 / 12期

关键词：

Acute cholangitis; Endoscopic biliary drainage; Antibiotic therapy; ACUTE SUPPURATIVE CHOLANGITIS; BILE-DUCT STONES; TRACT EMERGENCIES; RISK-FACTORS; MANAGEMENT; INFECTIONS; SEPSIS; SHOCK;

D O I：

10.1007/s00535-011-0451-5

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

100201 [内科学];

摘要：

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. 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 < 37A degrees 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. 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 < 37A degrees 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. Fever-based antibiotic therapy for acute cholangitis is safe and effective when resolution of fever is achieved following endoscopic biliary drainage.

引用

页码：1411 / 1417

页数：7

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