Modification and duration of therapy for acute acalculous cholecystitis

For patients with acute acalculous cholecystitis, 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 piperacillin+tazobactam if intravenous therapy is still required.

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).

The total duration of therapy (intravenous + oral) is 4 days after adequate surgical source control has been achievedSawyer, 2015. For the appropriateness of intravenous to oral switch and oral antibiotic choice, seek expert advice.