Acute cholangitis, a bacterial infection of the bile ducts, can be life-threatening if not diagnosed and treated timely. According to the European Society of Gastrointestinal Endoscopy, the American Society of Gastrointestinal Endoscopy, and the 2018 Tokyo Guidelines, the general treatment of this disease should involve a source control procedure along with antibiotic therapy (ABT). A systematic review was performed to determine the effect of length of ABT (short versus long) on acute cholangitis. Out of 692 articles produced by the search, only 4 met the inclusion and exclusion criteria. These involved 205 acute cholangitis patients. Of these, 137 and 68 patients received short and long ABT, respectively. The results did not show any significant difference in the outcomes of mortality and duration of fever after endoscopic retrograde cholangiopan creatography between the 2 groups. In 1 of 4 studies, the rate of recurrent cholangitis was remarkably lower in the short ABT group (0.0% vs. 13.3%, p = 0.036). Moreover, the length of hospitalization (only compared in the same retrospective article) was also found to be significantly shorter in the short ABT group (with a median of 14 vs. 17.5 days, p < 0.001). Based on this data, the researchers concluded that short-course ABT is non-inferior to long-course one. However, there is a need for well-designed randomized trials to confirm it.

Source: Dig Dis Sci. 2019 Feb;64(2):307-315.