Cholecystitis
- Diagnostic features include:
- fever
- right upper quadrant pain/tenderness, vomiting/food intolerance, Murphy’s sign
- elevated CRP and WBC
- imaging suggestive of gallbladder inflammation (abdominal ultrasound is the preferred initial imaging technique).
Acute
- Mild cases do not require antimicrobial therapy, other than cefazolin for surgical prophylaxis in high risk patients prior to cholecystectomy.
- For mild to moderate cholecystitis, postop antibiotics not recommended if focus of infection controlled by cholecystectomy.
- For severe cholecystitis, give antibiotics for maximum of 4 days post-cholecystectomy or IR drainage.
- If cholecystectomy delayed, and moderate to severe cholecystitis, give antibiotics according to below:
Usual Pathogens
Enterobacterales
Enterococcus spp
Anaerobes
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Ceftriaxone | 1-2g IV daily | 4-7 days |
| +/- | ||
| Metronidazole IV/PO | 500mg IV/PO q12h |
Alternative
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Amoxicillin-clavulanate | 1.2g IV q6h | 4-7 days |
Penicillin and ceftriaxone allergy
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Ciprofloxacin IV/PO | 400mg IV q12h/500mg PO bid | 4-7 days |
| +/- | ||
| Metronidazole IV/PO | 500mg IV/PO q12h |
Sepsis/Septic shock/Healthcare-associated infection
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Piperacillin-tazobactam | 4.5g IV q8h or | 4-7 days |
| 3.375g IV q6h |