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Biliary tract infections cholecystitis andcholangitis
EMPIRIC TREATMENTCommunity-acquired infections in patients
without previousbiliary procedures AND who are not severely ill
OR
OR
Hospital-acquired infections OR patients with multiple
therapeutic
biliary manipulations (e.g. stent placement/exchange,
bilio-entericanastamosis of any severity) OR patients who are
severely ill
OR
PLUS Metronidazole
500 mg IV Q8H
OR PLUS Metronidazole 500
mg IV Q8HVancomycin (see dosing section, p. 150)In severely ill
patients with cholangitis and complicated cholecystitis,
adequate biliary drainageis crucial as antibiotics will not
enter bile inthe presence of obstruction.
Duration Uncomplicated cholecystitis
NO post-procedure antibiotics are necessary if the obstruction
is
successfully relieved. not achieved.
achieved.
TREATMENT NOTES
Microbiology
E. coli, Klebsiella spp., Proteus spp.,P. aeruginosa(mainly in
patients already on broad-spectrum antibiotics
or those who have undergone prior procedures)
Bacteroides spp., generally in more serious infections, or
and community-acquired infections
Enterococcus spp
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6.1
Abdominalinfections
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Abdominalinfections
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Management
given until the biliary obstruction is relieved (either by
surgery, ERCP,
or percutaneous drain).
disease.
biliary cultures, not empirically.
Diverticulitis
EMPIRIC TREATMENT
NOTE: Patients with uncomplicated diverticulitis (defined as
CT
fever
and elevated inflammatory markers), can be treated
conservatively
without antibiotics based on a RCT.
Mild/moderate infections can be oral if patient can take PO
OR
PLUS Metronidazole 500 mg IV/PO Q8H
OR
OR
PLUS Metronidazole 500 mg IV/PO Q8H
Severe infections
OR
PLUS Metronidazole
500 mg IV Q8H
OR
PLUS Metronidazole 500 mg IV Q8H
Duration
