Empirical antibiotics for acute cholecystitis-what generation of antibiotics is an appropriate choice? A prospective, randomized controlled study.

BACKGROUND

In cases of acute cholecystitis (AC), empirical antibiotics are used to prevent infectious morbidities following cholecystectomy. However, there are still no exact guidelines on which antibiotics to use.

METHODS

We enrolled 300 patients who had been admitted for cholecystectomy because of grade I or II AC. We randomly allocated them to one of two groups empirically: the first group was to be given first-generation cephalosporins (group I, 150 patients) and the second group was to be given second-generation cephalosporins (group II, 150 patients). We analyzed the clinical outcomes and the incidence of postoperative infectious morbidities.

RESULTS

The incidence rate of overall infectious morbidities (18 cases, 12% in group I; 17 cases, 11.3% in group II; P = .859) showed no difference between the two groups. The incidence rate of sepsis (only one case, 0.7% in group II, P = 1.000) or surgical site infection (nine cases, 6% in group I and eight cases, 5.3% in group II, P = 1.000) were also similar in both groups.

CONCLUSIONS

The empirical use of first-generation cephalosporins for mild-to-moderate AC without gallbladder perforation was not inferior to using second-generation cephalosporin for prophylaxis against postoperative infection. Our results could allow for a tailored treatment strategy of empirical antibiotics according to the severity of the cholecystitis.