Modification and duration of therapy for acute calculous cholecystitis

For adults with acute calculous cholecystitis without signs of sepsis or septic shock who undergo a cholecystectomy, stop antibiotic therapy immediately after the procedureYokoe, 2018; randomised controlled trial data show no benefit from postoperative antibioticsKim, 2017Regimbeau, 2014.

For adults with sepsis or septic shock associated with acute cholecystitis, or who are awaiting cholecystectomy, use the results of culture and susceptibility testing to guide ongoing therapy (if available). If a gentamicin- or tobramycin-containing regimen was used and the results of susceptibility testing are not available 72 hours after the initial dose, switch to a non-aminoglycoside–containing regimen if intravenous therapy is still required. Switch to oral therapy once the patient is improving, haemodynamically stable and able to tolerate oral medication – see Guidance for antimicrobial intravenous to oral switch. If oral continuation therapy is required for adults with acute calculous cholecystitis, use:

For adults with hypersensitivity to penicillins, for oral continuation therapy, use:

The total duration of therapy (intravenous + oral) should not exceed 7 days.

Antifungal therapy may be required if yeast are identified in samples from deep surgical sites – seek expert advice and consult specialist guidelines (eg Consensus guidelines for the diagnosis and management of invasive candidiasis in haematology, oncology and intensive care settings).