Biliary Sepsis, Cholecystitis, Acute cholangitis (ascending)

Micro-organism

Coliforms, Enterococci

Duration

7 days (IV + oral)

Notes
  • Send blood for culture, 2 sets (20ml per set) if possible prior to starting antibiotics
  • Send bile sample at operation
  • Seek specialist advice if appropriate
  • Oral switch should be guided by antibiotic sensitivity if any positive microbiology available
First line

Gentamicin IV¥ (Hartford Regimen) as per guideline

Use preferred calculator on Hospital Portal page [intranet only] or calculator on app

+ Amoxicillin IV 1g 8 hourly

+/- Metronidazole IV 500mg 8 hourly

Switch to oral:

Doxycycline 100 - 200mg daily

+/- Metronidazole 400mg 8 hourly

OR

Co-trimoxazole 960mg 12 hourly

+/- Metronidazole 400mg 8 hourly

The addition of anaerobic cover with metronidazole is not normally required.

¥ If >72 hours IV therapy required, replace gentamicin with temocillin IV 2g 12 hourly

Penicillin Allergy or Gentamicin not appropriate

Co-trimoxazole IV* 960mg 12 hourly

+/- Metronidazole IV 500mg 8 hourly

Switch to oral:

Doxycycline 100 - 200mg daily

+/- Metronidazole 400mg 8 hourly

OR

Co-trimoxazole 960mg 12 hourly

+/- Metronidazole 400mg 8 hourly

The addition of anaerobic cover with metronidazole is not normally required.

*If co-trimoxazole IV unavailable and IV route required use ciprofloxacin 400mg IV 12 hourly and switch to oral co-trimoxazole as soon as appropriate