Abstract :
Background & Aims: To compare the efficacy and safety of short duration with standard 14 days of
antibiotic treatment in patients with acute cholangitis due to common bile duct stone (CBDS) after successful
endoscopic biliary drainage.
Methods: A prospective randomized study of patients with mild to moderate acute cholangitis due to
CBDS with symptoms duration of 48 hours or less. The patients were randomized at the time of ERCP to a short
duration (group A) or a standard fourteen days of antibiotic treatment (group B) from February 2013 to November
2013. Ceftriaxone was used as the antibiotic therapy in both groups. The endoscopic drainage by ERCP was done
within 72 hours after admission. The complete endoscopic drainage was defined when all the CBDSs were removed
and the incomplete endoscopic drainage was defined when some residual stones were present and the stent
insertion was needed. In the short duration treatment group, antibiotic was stopped when the patient was afebrile
for 72 hours.
Results: A total of 16 patients (7 female and 9 male) with the mean age of 69.8±15.4 years were recruited.
There were eight patients in group A and B. The demographic data, the abdominal pain intensity, liver function test
(LFT) and number of CBDS were not significantly different between the 2 groups. The clinical responses including
duration of fever, abdominal pain, improvement of LFT, and the number of patient with incomplete drainage after
treatment were similar between group A and B. The mean ± SD duration of antibiotic treatment in group A was 5 ±
1.7 days with a range of 4-9 days. There were 3 patients with bacteremia in each group but none of patients in both
groups developed recurrent cholangitis after 2 months of follow-up.
Conclusions: This data suggested that short duration antibiotic therapy for acute CBDS cholangitis after
successful endoscopic biliary drainage was safe and effective as the standard fourteen days antibiotic treatment. |
file/Thai-Journal-of-gastroenterology-vol-15-no-3-1635441.pdf