Antibiotic Duration for Moderate or Severe Acute Cholangitis

For acute cholangitis, guidelines suggest 4 to 7 days of antibiotics after successful biliary drainage (J Hepatobiliary Pancreat Sci 2018; 25:3), but randomized trials of antibiotic duration are lacking. In 120 patients with moderate (77%) or severe (23%) acute cholangitis in a single center in India, urgent biliary drainage was accomplished within 48 hours of admission; investigators then randomized them to receive either 4 days or 8 days of IV antibiotics. All patients also had received antibiotics before drainage. Antibiotics were continued beyond the randomized duration in any patient who did not meet predefined clinical stability criteria.

Clinical cure at 30 days (defined as no recurrent cholangitis and >50% reduction in bilirubin from…