Template:Cholecystitis Antibiotics
Most often isolated organisms are Escherichia coli, Klebsiella pneumonia, and anaerobes, especially Bacteroides fragilis
Uncomplicated
Pathogenicity of Enterococci remains unclear and specific coverage is not routinely suggested for community-acquired infections[1]
- Ertapenem 1g IV once daily OR
- Metronidazole 500mg IV q8hrs PLUS
- Ciprofloxacin 400mg IV q12 hrs OR
- Levofloxacin 750mg IV q24hrs OR
- Ceftriaxone 1g IV q24hrs
Complicated or Healthcare Associated
Examples of complication include severe sepsis or hemodynamic instability
- Vancomycin 15-20mg/kg PLUS any of the following options
Options:
- Metronidazole 500mg IV q8hrs PLUS Ciprofloxacin 400mg IV q12hrs
- Piperacillin/Tazobactam 4.5g IV q8hrs
- Imipenem/Cilastatin 500mg IV q6hrs
- Doripenem 500mg IV q8hrs
- Meropenem 1g IV q8hrs
Pediatric
- Ceftriaxone 50-75mg/kg IV daily (max 2g) + Metronidazole 7.5mg/kg IV q8hrs (max 500mg) OR
- Piperacillin/Tazobactam 80-100mg/kg IV q6-8hrs (max 4.5g) OR
- Meropenem 20mg/kg IV q8hrs (max 1g)
- ↑ Ansaloni L, et al. 2016 WSES guidelines on acute calculous cholecystitis. World Journal of Surgery. (2016) 11:25. DOI 10.1186/s13017-016-0082-5