Shorter duration of antibiotic treatment for acute bacteraemic cholangitis with successful biliary drainage: a retrospective cohort study

Abstract

SCT with a median duration of 6 days did not have worse outcomes than LCT with a median duration of 12 days. Shortening the duration of antimicrobial therapy may be a reasonable option when treating acute bacteraemic cholangitis following successful biliary drainage.

Shortening antibiotic duration in the treatment of acute cholangitis: rationale and study protocol for an open-label randomized controlled trial

“…The current trial will examine whether SCT for acute cholangitis with appropriate biliary duct drainage is not inferior to conventional LCT. A retrospective cohort study with propensity score analysis suggested that the efficacy of SCT as well as occurrence of complications are similar to those of LCT [6]. If non-inferiority was achieved, SCT has several advantages over LCT in terms of length of hospital stay, potential adverse effects from antimicrobial therapy, cost, and emergence of antimicrobial resistance [7][8][9][10].…”

“…The non-inferiority of SCT is concluded if the upper limit of the one-sided 97.5% confidence interval (CI) for the difference in clinical response (standard SCT) is less than 10%. To achieve a power of 80% with an α level of 2.5%, assuming as stated in the previous retrospective study a clinical cure rate of 95% with standard therapy with the same cure rate in SCT [6], with a noninferiority margin of − 10%, 75 patients are required in each group.…”

“…Antimicrobial therapy with appropriate biliary drainage is considered the standard of care [4,5], but the optimal duration of antimicrobial therapy remains unknown. The commonly used treatment for acute cholangitis is 7-10 days of antimicrobial therapy [5], but a recent retrospective cohort study suggested a shorter duration might be equally effective [6]. A shorter duration of antimicrobial therapy can be beneficial in decreasing the length of hospital stay, improving patients' quality of life, decreasing the adverse effects of antibiotics such as Clostridioides difficile infection, and even contributing to a decrease in the occurrence of antimicrobial resistance [7][8][9][10].…”

Shortening Antibiotic Duration in the Treatment of Acute Cholangitis. Rationale and Study Protocol for an Open Label Randomized Controlled Trial.

“…Therefore, the non-inferiority of SCT is concluded if the upper limit of the one-sided 97.5% confidence interval (CI) for the difference in clinical response (standard-SCT) is less than 10%. To achieve the power of 80% with α level of 2.5%, assuming as stated in the previous retrospective study with the clinical cure rate of 95% with standard therapy with the same cure rate in SCT [6], with a non-inferiority margin of -10%, 75 patients are required in each group.…”

“…Antimicrobial therapy with appropriate biliary drainage is considered the standard of care [4,5], but the optimal duration of antimicrobial therapy remains unknown. Seven to 10 days of antimicrobial therapy is common for the treatment of acute cholangitis [5] but a recent retrospective cohort study suggested a shorter duration might be equally effective [6]. A shorter duration of antimicrobial therapy can be beneficial in decreasing the length of hospital stay, improving patients' quality of life, decreasing the adverse effects of antibiotics such as Clostridioides difficile infection, and even contributing to a decrease in the occurrence of antimicrobial resistance [7][8][9][10].…”