Skip to main content

Advertisement

SpringerLink
Log in

Bacterial cholangitis

  • Published:
Current Treatment Options in Gastroenterology Aims and scope Submit manuscript

Opinion statement

The treatment of acute bacterial cholangitis requires broad-spectrum antibiotics to cover against gram-negative aerobic enteric organisms (Escherichia coli, Klebsiella species, and Enterobacter species), gram-positive Enterococcus and anaerobic bacteria (Bacteroides fragilis and Clostridium perfringens). Approximately 20% of patients with acute cholangitis fail to respond to conservative treatment with antibiotic therapy and require urgent biliary decompression, which is the mainstay of therapy. This is best accomplished by endoscopic retrograde cholangiopancreatography (ERCP) and placement of a nasobiliary drainage tube or a large bore (10 F or larger) indwelling plastic stent. Alternative therapy includes percutaneous transhepatic biliary drainage or surgical biliary decompression, but these carry a significantly higher morbidity and mortality. Supportive care includes intravenous fluid hydration to prevent renal failure and close monitoring of vital signs for determination of potential septicemia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Nomura T, Shirai Y, Hatakeyama K: Cholangitis in malignant biliary obstruction. Br J Surg 1998, 85:407.

    Article  PubMed  CAS  Google Scholar 

  2. Boey JH, Way L: Acute cholangitis. Ann Surg 1980, 191:264–270.

    Article  PubMed  CAS  Google Scholar 

  3. Leung JWC, Ling TKW, Chan RCY, et al.: Antibiotics, biliary sepsis, and bile duct stones. Gastrointest Endosc 1994, 40:716–721. This study demonstrates ciprofloxacin as the antibiotic of choice for the treatment of cholangitis because it penetrates into the bile even in obstructed patients.

    PubMed  CAS  Google Scholar 

  4. Westphal JF, Brogard JM: Biliary tract infections: a guide to drug treatment. Drugs 1999, 57:81–91. This paper is a good guide to empiric antibiotic therapy for cholangitis.

    Article  PubMed  CAS  Google Scholar 

  5. Sung JJ, Lyon DJ, Suen R, et al.: Intravenous ciprofloxacin as treatment for patients with acute suppurative cholangitis: a randomized, controlled clinical trial. J Antimicrob Chemother 1995, 35:855–864. This randomized trial demonstrates the equal efficacy of ciprofloxacin alone to triple antibiotic regimen.

    Article  PubMed  CAS  Google Scholar 

  6. Lau JYW, Ip SM, Chung SCS, et al.: Endoscopic drainage aborts endotoxaemia in acute cholangitis. Br J Surg 1996, 83:181–184.

    Article  PubMed  CAS  Google Scholar 

  7. Sung JJY, Leung JCK, Tsui CP, et al.: Biliary IgA secretion in obstructive jaundice: The effects of endoscopic drainage. Gastrointest Endosc 1995, 42:439–444.

    Article  PubMed  CAS  Google Scholar 

  8. Lai ECS, Mok FPT, Tan ESY, et al.: Endoscopic biliary drainage for severe acute cholangitis. N Engl J Med 1992, 326:1582–1586. This randomized study shows the superior benefit of endoscopic biliary drainage versus surgical biliary drainage.

    Article  PubMed  CAS  Google Scholar 

  9. Leung JWC, Chung SCS, Sung JJY, et al.: Urgent endoscopic drainage for severe acute suppurative cholangitis. Lancet 1989, 1:1307–1309.

    Article  PubMed  CAS  Google Scholar 

  10. Leese T, Neoptolemos JP, Baker AR, et al.: Management of acute cholangitis and the impact of endoscopic sphincterotomy. Br J Surg 1986, 73:988–992.

    Article  PubMed  CAS  Google Scholar 

  11. Lai ECS, Tam P, Paterson IA, et al.: Emergency surgery for severe acute cholangitis. Ann Surg 1989, 211:55–59.

    Article  Google Scholar 

  12. Boender J, Nix GA, de Ridder MA, et al.: Endoscopic sphincterotomy and biliary drainage in patients with cholangitis due to common duct stones. Am J Gastroenterol 1995, 90:233–238.

    PubMed  CAS  Google Scholar 

  13. Sugiyama M, Atomi Y: The benefits of endoscopic nasobiliary drainage without sphincterotomy for acute cholangitis. Am J Gastroenterol 1998, 93:2065–2068. This study shows the safety of endoscopic biliary drainage without pre-cut sphincterotomy.

    Article  PubMed  CAS  Google Scholar 

  14. Sugiyama M, Atomi Y: Treatment of acute cholangitis due to choledocholithiasis in elderly and younger patients. Arch Surg 1997, 132:1129–1133. This study shows the benefits of endoscopic drainage as compared with surgery or percutaneous transhepatic drainage.

    PubMed  CAS  Google Scholar 

  15. American Health Formulary Service, American Society of Health-System Pharmacists, Inc: 2000 Edition. Edited by McEvoy GK. Bethesda, MD: American Society of Health-System Pharmacists; 2000.

    Google Scholar 

  16. Gerecht WB, Henry NK, Hoffman WW, et al.: Prospective randomized comparison of mezlocillin therapy alone with combined ampicillin and gentamicin therapy for patients with cholangitis. Arch Intern Med 1989, 149:1279–1284.

    Article  PubMed  CAS  Google Scholar 

  17. Lee JG: Role of endoscopic therapy in cholangitis. Am J Gastroenterol 1998, 93:2016–2018.

    Article  PubMed  CAS  Google Scholar 

  18. Freeman ML, Nelson DB, Sherman S, et al.: Complications of endoscopic biliary sphincterotomy. N Engl J Med 1996, 335:909–918.

    Article  PubMed  CAS  Google Scholar 

  19. Lois JF, Gomes AS, Grace PA, et al.: Risks of percutaneous transhepatic drainage in patients with cholangitis. Am J Roentgenol 1987, 148:367–371.

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Gastroenterology, University of California, Davis Health Care System, 4150 V Street, Suite 3500, 95817, Sacramento, CA, USA

    Donald F. Lum MD & Joseph W. Leung MD, FRCP

Authors
  1. Donald F. Lum MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joseph W. Leung MD, FRCP
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lum, D.F., Leung, J.W. Bacterial cholangitis. Curr Treat Options Gastro 4, 139–146 (2001). https://doi.org/10.1007/s11938-001-0026-2

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11938-001-0026-2

Keywords

Search

Navigation