Short Duration versus 14-day Antibiotic Treatment in Acute Cholangitis due to Bile Duct Stone: A randomized study

Abstract

BaCKGROUND and Aims: The optimum duration of antibiotic therapy in common bile duct stone associated cholangitis is not well established. We aimed to assess the efficacy and safety of short antibiotic therapy in acute cholangitis associated with common bile duct stone.

Methods: Eighteen (9 mild cholangitis and 9 moderate cholangitis) were recruited in group A (antibiotic cessation when fever subsided for 72 hours) and 16 (mild cholangitis and 8 moderate cholangitis) were recruited in group B (a full 2 weeks of antibiotic therapy). Both groups were evaluated and compared in term of the recurrence rate, duration of fever, abdominal pain, hospital stay and complications. The duration of antibiotic therapy in group A and in patients with or without bacteremia were evaluated and compared.

Results: No recurrence occured in group A and 1 recurrence occured in group B (p = 0.485). Clinical outcomes were similar between the 2 groups. The fever duration was similar between mild and moderate cholangitis within the same group and between the 2 groups. Duration of antibiotic therapy in group A was 4.61+/-1.37 days with 16 (88%) needing treatment for <5 days. The duration of treatment was similar between patients with or without bacteremia. The hospital stay was similar in both groups and no complications occured.

Conclusion: Short duration antibiotic therapy based on fever resolution of 72 hours was effective and safe in patients with mild to moderate cholangitis due to common bile duct stone.