A RECENT study on antimicrobial therapies for patients with acute cholangitis (AC) has suggested that a shorter duration of antimicrobial therapy might be sufficient for successful outcomes, even in febrile patients. The research, led by Sakue Masuda, Department of Gastroenterology, Shonan Kamakura General Hospital, Japan, challenges the traditional 4–7 day antimicrobial regimen, presenting evidence that a ≤2–3-day course following biliary drainage could be equally effective.
The study conducted a retrospective analysis on a cohort of 408 patients diagnosed with AC who underwent successful biliary drainage, and completed a course of antibiotics that lasted less than 7 days. These patients were categorised into febrile and afebrile groups based on their body temperature 24 hours before completing antimicrobial treatment. The primary measured outcome was the clinical cure rate, defined by the absence of initial presenting symptoms by day 14 post-biliary drainage, without recurrence or death by day 30 and the secondary measured outcome was the 3-month recurrence rate.
Their results indicated no significant difference in the clinical cure and 3-month recurrence rates between the febrile and afebrile groups. This suggests that discontinuing antibiotics within the initially planned treatment period is sufficient for patients with successful biliary drainage, irrespective of fever status. The findings are crucial in the context of antimicrobial resistance as prolonged antibiotic use is known to increase the risk of developing resistant organisms and associated complications like Clostridium difficile enteritis and invasive candidiasis.
The study suggests that a shorter duration of antimicrobial therapy could be sufficient for treating AC, even in febrile patients, provided the infection source is well controlled. This approach could play a significant role in combating antimicrobial resistance and improving patient outcomes. However, despite these promising findings, the study acknowledges several limitations, including the retrospective design and the exclusion of patients with hypothermia or severe early warning scores. Further research, particularly randomised controlled trials, is necessary to confirm these results and refine guidelines for the management of AC.
Katie Wright, EMJ
Reference
Masuda S et al. Comparison of antimicrobial therapy termination in febrile and afebrile patients with acute cholangitis after drainage. Sci Rep. 2024;14(1):17858.
