Antibiotic Administration within Two Days after Successful Endoscopic Retrograde Cholangiopancreatography Is Sufficient for Mild and Moderate Acute Cholangitis

Abstract

To prevent the increase of resistant bacteria, it is important to minimize the use of antimicrobial agents. Studies have found that administration for ≤3 days after successful endoscopic retrograde cholangiopancreatography (ERCP) is appropriate. Therefore, the present study aimed to verify if administration of antimicrobial agents can be further shortened to ≤2 days after ERCP. We divided 390 patients with mild and moderate cholangitis who underwent technically successful ERCP from January 2018 to June 2020 and had positive blood or bile cultures into two groups: antibiotic therapy within two days of ERCP (short-course therapy, SCT; n = 59, 15.1%), and for >3 days (long-course therapy, LCT; n = 331, 84.9%). The increased severity after admission and other outcomes were compared between the two groups, and the risk factors for increased severity were verified. There were no between-group differences in patient characteristics. Total length of hospital stay was shorter in SCT than in LCT, and other outcomes in SCT were not significantly different from those in LCT. Being 80 or older was a risk factor for increased severity; however, SCT was not associated with increased severity. Antimicrobial therapy for ≤2 days after successful ERCP is adequate in patients with mild and moderate acute cholangitis.

Antimicrobial therapy outcomes in acute cholangitis: Hilar multiple obstructions versus single hilar and common bile duct obstructions

“…Our investigation suggests that the outcomes of patients with AC with multiple hilar biliary obstructions may be poor. Although it is challenging to fully align our definition of outcomes with those of previous reports, the clinical cure rate of Group 3 was 87.1%, which is inferior when compared with those of Groups 1 and 2 or previous reports 4–6 . Unlike the simple obstruction in the bile ducts outside the liver, in cases of multiple hilar biliary obstructions, it is sometimes difficult to achieve complete drainage of the entire bile duct.…”

“…19 We considered antimicrobial therapy duration as an important factor to investigate based on previous reports indicating that it can be shortened compared with the recommended duration in the TG18. [4][5][6] To assess the conditions of patients immediately before the discontinuation of antibiotics, we incorporated NEWS into our analysis. The United Kingdom's National Early Warning Score Development and Implementation Group developed the NEWS to assess deteriorating conditions in hospitalized patients and to predict inpatient death or intensive care unit (ICU) admission.…”

“…This evidence proposes that administering antimicrobials for a short duration after biliary drainage represents a viable and reasonable approach for the treatment of AC. [4][5][6] To our knowledge, no study has investigated whether AC resulting from multiple hilar biliary obstructions requires a similar duration of antimicrobial treatment as AC resulting from simple obstruction in the extrahepatic bile duct, which the TG18 guidelines treat equally. 3 Bismuth-IV obstruction (Figure S1, Supporting information) has been reported to have a higher clinical failure rate for bile duct drainage than other hilar obstruction.…”

“…Recent research findings suggest that the brief use of antimicrobials, lasting only 1–3 days following biliary drainage, is comparable in efficacy to the conventional treatment duration for AC. This evidence proposes that administering antimicrobials for a short duration after biliary drainage represents a viable and reasonable approach for the treatment of AC 4–6 …”

Clinical Advances in the Diagnosis and Treatment of Biliary Tract Diseases

“…Recently, shorter durations have been recommended to prevent the emergence of resistant organisms, shorten hospital stays, and reduce costs. For mild or moderate cholangitis, two days of antibiotics administration may be sufficient [ 10 ] if an appropriate drainage is performed. Transpapillary drainage was also shown to be safe and possibly effective for severe cholangitis with disseminated intravascular coagulation (DIC) [ 11 ].…”