Management of acute cholangitis

Acute (ascending) cholangitis is a medical emergency. Urgent relief of biliary obstruction and prompt antibiotic therapy is required.

Acute cholangitis is usually associated with gram-negative bacteraemia and less commonly with enterococcal or polymicrobial infectionTian 2022. Biliary infection may also occur after endoscopic retrograde cholangiopancreatography (ERCP), although this is rare. Patients with chronic biliary obstruction are more likely to have an infection involving anaerobic bacteria.

Take blood samples for culture and susceptibility testing before starting antibiotic therapy. See also Assessment of intra-abdominal infections.