Center for Global Health, Mito Kyodo General Hospital, University of Tsukuba, Ibaraki, Japan.
Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
J Hepatobiliary Pancreat Sci. 2018 Jan;25(1):3-16. doi: 10.1002/jhbp.518. Epub 2018 Jan 9.
Antimicrobial therapy is a mainstay of the management for patients with acute cholangitis and/or cholecystitis. The Tokyo Guidelines 2018 (TG18) provides recommendations for the appropriate use of antimicrobials for community-acquired and healthcare-associated infections. The listed agents are for empirical therapy provided before the infecting isolates are identified. Antimicrobial agents are listed by class-definitions and TG18 severity grade I, II, and III subcategorized by clinical settings. In the era of emerging and increasing antimicrobial resistance, monitoring and updating local antibiograms is underscored. Prudent antimicrobial usage and early de-escalation or termination of antimicrobial therapy are now important parts of decision-making. What is new in TG18 is that the duration of antimicrobial therapy for both acute cholangitis and cholecystitis is systematically reviewed. Prophylactic antimicrobial usage for elective endoscopic retrograde cholangiopancreatography is no longer recommended and the section was deleted in TG18. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.
抗菌治疗是急性胆管炎和/或胆囊炎患者治疗的主要手段。2018 年东京指南（TG18）为社区获得性和医疗保健相关性感染提供了抗菌药物合理使用的建议。列出的药物是在确定感染分离株之前进行经验性治疗的药物。抗菌药物按类别定义和 TG18 严重程度 I、II 和 III 进行分类，并按临床情况进行细分。在出现和不断增加的抗菌药物耐药性的时代，强调了监测和更新当地抗菌药物图谱的重要性。审慎使用抗菌药物以及尽早降级或停止抗菌治疗现在是决策的重要组成部分。TG18 的新内容是系统地审查了急性胆管炎和胆囊炎的抗菌治疗持续时间。不再推荐预防性使用抗菌药物进行选择性内镜逆行胰胆管造影，因此该部分在 TG18 中被删除。完整的免费文章和 TG18 的移动应用程序可在以下网址获得：http://www.jshbps.jp/modules/en/index.php?content_id=47。还包括相关的临床问题和参考文献。
