Antibiotic Therapy of 3 Days May Be Sufficient After Biliary Drainage for Acute Cholangitis: A Systematic Review.
Acute cholangitis
Antibiotic therapy duration
Antimicrobial stewardship
Biliary drainage
Systematic review
Journal
Digestive diseases and sciences
ISSN: 1573-2568
Titre abrégé: Dig Dis Sci
Pays: United States
ID NLM: 7902782
Informations de publication
Date de publication:
12 2021
12 2021
Historique:
received:
16
09
2020
accepted:
31
12
2020
pubmed:
20
1
2021
medline:
15
12
2021
entrez:
19
1
2021
Statut:
ppublish
Résumé
The optimal antibiotic therapy duration for cholangitis is unclear. Guideline recommendations vary between 4 and 14 days after biliary drainage. Clinical observations and some evidence however suggest that shorter antibiotic therapy may be sufficient. To compare the effectiveness and safety of short-course therapy of ≤ 3 days with long-course therapy of ≥ 4 days after biliary drainage in cholangitis patients. We searched the databases PubMed, EMBASE, Cochrane Library, and trial registers for literature up to August 5, 2020. RCTs and observational studies including case series reporting on antibiotic therapy duration for acute cholangitis were eligible for inclusion. Two reviewers independently evaluated study eligibility, extracted data, assessed risk of bias and quality of evidence. A meta-analysis was planned if the included studies were comparable with regard to important study characteristics. Primary outcomes included recurrent cholangitis, subsequent other infection, and mortality. We included eight studies with 938 cholangitis patients. Four observational studies enrolled patients treated for ≤ 3 days. Recurrent cholangitis occurred in 0-26.8% of patients treated with short-course therapy, which did not differ from long-course therapy (range 0-21.1%). Subsequent other infection and mortality rates were also comparable. Quality of available evidence was very low. There is no high-quality evidence available to draw a strong conclusion, but heterogeneous observational studies suggest that antibiotic therapy of ≤ 3 days is sufficient in cholangitis patients with common bile duct stones.
Sections du résumé
BACKGROUND
The optimal antibiotic therapy duration for cholangitis is unclear. Guideline recommendations vary between 4 and 14 days after biliary drainage. Clinical observations and some evidence however suggest that shorter antibiotic therapy may be sufficient.
OBJECTIVE
To compare the effectiveness and safety of short-course therapy of ≤ 3 days with long-course therapy of ≥ 4 days after biliary drainage in cholangitis patients.
METHODS
We searched the databases PubMed, EMBASE, Cochrane Library, and trial registers for literature up to August 5, 2020. RCTs and observational studies including case series reporting on antibiotic therapy duration for acute cholangitis were eligible for inclusion. Two reviewers independently evaluated study eligibility, extracted data, assessed risk of bias and quality of evidence. A meta-analysis was planned if the included studies were comparable with regard to important study characteristics. Primary outcomes included recurrent cholangitis, subsequent other infection, and mortality.
RESULTS
We included eight studies with 938 cholangitis patients. Four observational studies enrolled patients treated for ≤ 3 days. Recurrent cholangitis occurred in 0-26.8% of patients treated with short-course therapy, which did not differ from long-course therapy (range 0-21.1%). Subsequent other infection and mortality rates were also comparable. Quality of available evidence was very low.
CONCLUSION
There is no high-quality evidence available to draw a strong conclusion, but heterogeneous observational studies suggest that antibiotic therapy of ≤ 3 days is sufficient in cholangitis patients with common bile duct stones.
Identifiants
pubmed: 33462749
doi: 10.1007/s10620-020-06820-3
pii: 10.1007/s10620-020-06820-3
pmc: PMC8589797
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
4128-4139Informations de copyright
© 2021. The Author(s).
Références
J Hepatobiliary Pancreat Sci. 2018 Jan;25(1):31-40
pubmed: 28941329
Int J Infect Dis. 2017 Feb;55:81-85
pubmed: 28027992
Trials. 2020 Jan 17;21(1):97
pubmed: 31952554
Dig Dis Sci. 2014 Nov;59(11):2790-6
pubmed: 24898101
N Engl J Med. 2015 May 21;372(21):1996-2005
pubmed: 25992746
Endoscopy. 2019 May;51(5):472-491
pubmed: 30943551
Gastrointest Endosc. 2002 Apr;55(4):518-22
pubmed: 11923764
Surg Infect (Larchmt). 2017 Aug/Sep;18(6):659-663
pubmed: 28650745
BMJ. 2016 Oct 12;355:i4919
pubmed: 27733354
J Gastroenterol. 2011 Dec;46(12):1411-7
pubmed: 21842232
BMJ. 2019 Aug 28;366:l4898
pubmed: 31462531
BMC Infect Dis. 2014 Jan 09;14:13
pubmed: 24405683
Intensive Care Med. 2017 Mar;43(3):304-377
pubmed: 28101605
Dig Dis Sci. 2019 Feb;64(2):307-315
pubmed: 30368681
J Am Coll Surg. 2016 Apr;222(4):440-6
pubmed: 26920994
Surg Infect (Larchmt). 2014 Aug;15(4):417-24
pubmed: 24824591
Clin Transl Gastroenterol. 2020 Mar;11(3):e00158
pubmed: 32352721
World J Emerg Surg. 2017 Jul 10;12:29
pubmed: 28702076
Int J Infect Dis. 2020 Jul;96:343-347
pubmed: 32376307
Surg Infect (Larchmt). 2017 Jan;18(1):1-76
pubmed: 28085573
BMJ. 2009 Jul 21;339:b2535
pubmed: 19622551
United European Gastroenterol J. 2020 May;8(4):481-488
pubmed: 32213042
Clin Microbiol Infect. 2018 Nov;24(11):1184-1189
pubmed: 29408612
JAMA Intern Med. 2017 Sep 1;177(9):1308-1315
pubmed: 28604925
Clin Infect Dis. 1994 Aug;19(2):279-86
pubmed: 7986900
JAMA. 2016 Sep 20;316(11):1193-1204
pubmed: 27654605
J Hepatobiliary Pancreat Sci. 2018 Jan;25(1):3-16
pubmed: 29090866
World J Emerg Surg. 2016 Jul 15;11:33
pubmed: 27429642