Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
J Gastroenterol. 2011 Dec;46(12):1411-7. doi: 10.1007/s00535-011-0451-5. Epub 2011 Aug 13.
The current management of acute cholangitis consists of antibiotic therapy in combination with biliary drainage. However, the optimal duration of antibiotic therapy after the resolution of clinical symptoms by biliary drainage is unclear. We aimed to evaluate whether discontinuing antibiotic therapy for acute cholangitis immediately after the resolution of clinical symptoms, achieved by endoscopic biliary drainage, was safe and effective.
This prospective study included patients with moderate and severe acute cholangitis. Cefmetazole sodium and meropenem hydrate were used as initial antibiotic therapy for patients with moderate and severe acute cholangitis, respectively. All patients underwent endoscopic biliary drainage within 24 h of diagnosis. When the body temperature of < 37 ° C was maintained for 24 h, administration of antibiotics was stopped. The primary endpoint was the recurrence of acute cholangitis within 3 days after the withdrawal of antibiotic therapy.
Eighteen patients were subjected to the final analysis. The causes of cholangitis were bile duct stone (n = 17) and bile duct cancer (n = 1). The severity of acute cholangitis was moderate in 14 patients and severe in 4. Body temperature of < 37 ° C was achieved in all patients after a median of 2 days (range 1-6) following endoscopic biliary drainage. Antibiotic therapy was administered for a median duration of 3 days (range 2-7). None of the patients developed recurrent cholangitis within 3 days after the withdrawal of antibiotics.
Fever-based antibiotic therapy for acute cholangitis is safe and effective when resolution of fever is achieved following endoscopic biliary drainage.
急性胆管炎的当前治疗方法包括抗生素治疗联合胆道引流。然而，经胆道引流解除临床症状后抗生素治疗的最佳持续时间尚不清楚。我们旨在评估在经内镜胆道引流解除临床症状后立即停止急性胆管炎的抗生素治疗是否安全有效。
这项前瞻性研究纳入了中度和重度急性胆管炎患者。头孢美唑钠和美罗培南分别用于治疗中度和重度急性胆管炎患者的初始抗生素治疗。所有患者均在诊断后 24 小时内行内镜胆道引流。当体温 < 37°C 持续 24 小时时，停止使用抗生素。主要终点是在停止抗生素治疗后 3 天内急性胆管炎的复发。
18 例患者最终纳入分析。胆管炎的病因是胆管结石（n = 17）和胆管癌（n = 1）。14 例患者为中度急性胆管炎，4 例为重度急性胆管炎。内镜胆道引流后，所有患者的体温中位数在 2 天（范围 1-6）内降至 < 37°C。抗生素治疗的中位持续时间为 3 天（范围 2-7）。停止抗生素治疗后 3 天内，无患者发生复发性胆管炎。
经内镜胆道引流解除发热后，基于发热的急性胆管炎抗生素治疗是安全有效的。
