van den Hazel S J, Speelman P, Tytgat G N, Dankert J, van Leeuwen D J
Department of Gastroenterology, University of Amsterdam, The Netherlands.
Clin Infect Dis. 1994 Aug;19(2):279-86. doi: 10.1093/clinids/19.2.279.
Cholangitis is usually the consequence of a combination of factors: impairment of the flow of bile and bacterial colonization of the biliary tract. Although reestablishing biliary drainage is the mainstay of treatment, antibiotics play an important role in the management of cholangitis. In this review, the use of antibiotics for treatment, prophylaxis, and maintenance therapy is discussed. Antibiotics for the treatment of acute cholangitis should be given for 7-10 days in therapeutic dosages and may allow a more selective timing of further interventions. Antibiotic prophylaxis for cholangitis ought to be given as a single (high) dose shortly before surgical or nonsurgical manipulations of the biliary system. Patients with a compromised biliary system (e.g., on account of an endoprosthesis in situ or hepaticojejunostomy) who are prone to develop recurrent bouts of cholangitis may benefit from antibiotic maintenance therapy, given daily in lower-than-therapeutic dosages.
胆汁流动受阻和胆道细菌定植。虽然重建胆道引流是治疗的主要手段，但抗生素在胆管炎的治疗中也起着重要作用。在本综述中，讨论了抗生素在治疗、预防和维持治疗中的应用。治疗急性胆管炎的抗生素应以治疗剂量给药7至10天，这可能会使进一步干预的时机更具选择性。胆管炎的抗生素预防应在胆道系统进行手术或非手术操作前不久单次（高剂量）给药。胆道系统受损（例如，由于原位内置假体或肝空肠吻合术）且容易反复发作胆管炎的患者，可能会从以低于治疗剂量每日给药的抗生素维持治疗中获益。
