What are the initial treatments and antibiotic regimens for acute cholecystitis?

Updated: May 20, 2021
  • Author: Alan A Bloom, MD; Chief Editor: BS Anand, MD  more...
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Answer

In acute cholecystitis, the initial treatment includes bowel rest, intravenous hydration, correction of electrolyte abnormalities, analgesia, and intravenous antibiotics. For mild cases of acute cholecystitis, antibiotic therapy with a single broad-spectrum antibiotic is adequate. Some options include the following:

  • The current Sanford guide recommendations include piperacillin/tazobactam (Zosyn, 3.375 g IV q6h or 4.5 g IV q8h), ampicillin/sulbactam (Unasyn, 3 g IV q6h), or meropenem (Merrem, 1 g IV q8h). In severe life-threatening cases, the Sanford Guide recommends imipenem/cilastatin (Primaxin, 500 mg IV q6h).

  • Alternative regimens include a third-generation cephalosporin plus metronidazole (Flagyl, 1 g IV loading dose followed by 500 mg IV q6h).

  • Bacteria that are commonly associated with cholecystitis include Escherichia coli and Bacteroides fragilis, as well as Klebsiella, Enterococcus, and Pseudomonas species.

  • Emesis can be treated with antiemetics and nasogastric suction.

  • Because of the rapid progression of acute acalculous cholecystitis to gangrene and perforation, early recognition and intervention are required.

  • Supportive medical care should include restoration of hemodynamic stability and antibiotic coverage for gram-negative enteric flora and anaerobes if biliary tract infection is suspected.

  • Daily stimulation of gallbladder contraction with intravenous cholecystokinin (CCK) has been shown by some to effectively prevent the formation of gallbladder sludge in patients receiving total parenteral nutrition (TPN).


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