Tokyo Guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis
Open accessAbstract
Antimicrobial therapy is a mainstay of the management for patients with acute cholangitis and/or cholecystitis. The Tokyo Guidelines 2018 ( TG 18) provides recommendations for the appropriate use of antimicrobials for community‐acquired and healthcare‐associated infections. The listed agents are for empirical therapy provided before the infecting isolates are identified. Antimicrobial agents are listed by class‐definitions and TG 18 severity grade I, II , and III subcategorized by clinical settings. In the era of emerging and increasing antimicrobial resistance, monitoring and updating local antibiograms is underscored. Prudent antimicrobial usage and early de‐escalation or termination of antimicrobial therapy are now important parts of decision‐making. What is new in TG 18 is that the duration of antimicrobial therapy for both acute cholangitis and cholecystitis is systematically reviewed. Prophylactic antimicrobial usage for elective endoscopic retrograde cholangiopancreatography is no longer recommended and the section was deleted in TG 18. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47 . Related clinical questions and references are also included.
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Biliary infections are often polymicrobial.
“Biliary infections are often polymicrobial and the choice of the antibiotic should be directed by local practice considering bacterial sensitivities and the degree of liver and/or renal impairment.233”
From EASL Clinical Practice Guidelines on sclerosing cholangitis (2022) · cites this paper as [233]
Most patients will respond to endoscopic drainage of the obstruction in combination with antibiotics.
“but most patients will respond to endoscopic drainage of the obstruction in combination with antibiotics.231,233”
From EASL Clinical Practice Guidelines on sclerosing cholangitis (2022) · cites this paper as [233]
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Edergren, Å., Sandblom, G., Agustsson, T., & Jaafar, G. (2022) · British journal of surgery · doi:10.1093/bjs/znac351 · Cited by 10 · see citing works
- Authors
- Gomi, H., Solomkin, J. S., Schlossberg, D., Okamoto, K., Takada, T., Strasberg, S. M., Ukai, T., Endo, I., Iwashita, Y., Hibi, T., Pitt, H. A., Matsunaga, N., Takamori, Y., Umezawa, A., Asai, K., Suzuki, K., Han, H., Hwang, T., Mori, Y., Yoon, Y., Huang, W. S., Belli, G., Dervenis, C., Yokoe, M., Kiriyama, S., Itoi, T., Jagannath, P., Garden, O. J., Miura, F., de Santibañes, E., Shikata, S., Noguchi, Y., Wada, K., Honda, G., Supe, A. N., Yoshida, M., Mayumi, T., Gouma, D. J., Deziel, D. J., Liau, K., Chen, M., Liu, K., Su, C., Chan, A. C. W., Yoon, D., Choi, I., Jonas, E., Chen, X., Fan, S. T., Ker, C., Giménez, M. E., Kitano, S., Inomata, M., Mukai, S., Higuchi, R., Hirata, K., Inui, K., Sumiyama, Y., & Yamamoto, M.
- Affiliations
- University of Tsukuba (JP)
- University of Cincinnati (US)
- Temple University (US)
- Kitakyushu City Hospital Organization (JP)
- Teikyo University (JP)
- Washington University in St. Louis (US)
- Department of Family Medicine Mie Prefectural Ichishi Hospital Mie Japan
- Yokohama City University (JP)
- Oita University (JP)
- Keio University (JP)
- Yotsuya Medical Cube (JP)
- Toho University Ohashi Medical Center (JP)
- Fujinomiya City General Hospital (JP)
- Seoul National University (KR)
- Taoyuan Chang Gung Memorial Hospital (TW)
- Kyushu University (JP)
- Chang Bing Show Chwan Memorial Hospital (TW)
- Ospedale Santa Maria di Loreto Nuovo (IT)
- Agia Olga Hospital (GR)
- Japanese Red Cross Nagoya Daini Hospital (JP)
- Ogaki Municipal Hospital (JP)
- Tokyo Medical University Hospital (JP)
- Lilavati Hospital & Research Centre (IN)
- University of Edinburgh (GB)
- Department of Surgery, Hospital Italiano University of Buenos Aires Buenos Aires Argentina
- Mie Prefectural Ichishi Hospital Mie Japan
- Tokyo Metropolitan Komagome Hospital (JP)
- King Edward Memorial Hospital and Seth G.S. Medical College (IN)
- Japan Council for Quality Health Care (JP)
- University of Occupational and Environmental Health Japan (JP)
- Amsterdam UMC Location University of Amsterdam (NL)
- Rush University Medical Center (US)
- National University of Singapore (SG)
- Cheng Hsin General Hospital (TW)
- Hong Kong Sanatorium and Hospital (HK)
- Yonsei University (KR)
- Konyang University Hospital (KR)
- University of Cape Town (ZA)
- Hepatic Surgery Centre Department of Surgery Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China
- Yuan's General Hospital (TW)
- Universidad de Buenos Aires (AR)
- Tokyo Women's Medical University (JP)
- JR Sapporo Hospital (JP)
- Fujita Health University (JP)
- Toho University (JP)
- Corresponding author
- Takada, Tadahiro
- ORCID
- Gomi, Harumi
- Solomkin, Joseph S.
- Okamoto, Kohji
- Takada, Tadahiro
- Strasberg, Steven M.
- Ukai, Tomohiko
- Endo, Itaru
- Iwashita, Yukio
- Hibi, Taizo
- Pitt, Henry A.
- Umezawa, Akiko
- Asai, Koji
- Suzuki, Kenji
- Han, Ho‐Seong
- Hwang, Tsann‐Long
- Mori, Yasuhisa
- Yoon, Yoo‐Seok
- Kiriyama, Seiki
- Itoi, Takao
- Jagannath, Palepu
- Garden, O. James
- Shikata, Satoru
- Noguchi, Yoshinori
- Honda, Goro
- Supe, Avinash Nivritti
- Yoshida, Masahiro
- Mayumi, Toshihiko
- Chen, Miin‐Fu
- Yoon, Dong‐Sup
- Choi, In‐Seok
- Jonas, Eduard
- Fan, Sheung Tat
- Ker, Chen‐Guo
- Giménez, Mariano Eduardo
- Inomata, Masafumi
- Mukai, Shuntaro
- Higuchi, Ryota
- Hirata, Koichi
- Yamamoto, Masakazu
- Venue
- Journal of Hepato-Biliary-Pancreatic Sciences
- Publisher
- Wiley
- Published
- 2018-01
- Volume
- 25
- Issue
- 1
- Pages
- 3-16
- ISSN
- 1868-6974 (ISSN-L)
- 1868-6982
- OpenAlex
- W2765864331
- Cited by
- 451
- References
- 76
- Citations by year
- 2026: 58 · 2025: 65 · 2024: 56 · 2023: 52 · 2022: 61 · 2021: 71 · 2020: 41 · 2019: 31 · 2018: 12 · 2017: 3 · 2014: 1
- FWCI
- 4.34
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Hepato-Biliary-Pancreatic Sciences (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Institutional Repositories DataBase (IRDB) (submittedVersion)
- Funders
- Washington University in St. Louis
- University of Pittsburgh
- University of Cincinnati
- Rush University
- Temple University
- University of Occupational and Environmental Health
- Teikyo University School of Medicine
- Seoul National University Bundang Hospital
- National University of Singapore
- Keio University
- Konyang University
- Seoul National University
- Yonsei University
- Huazhong University of Science and Technology
- Tongji University
- Chang Gung Medical Foundation
- Universidad de Buenos Aires
- University of Tsukuba
- University of Cape Town
- Fujita Health University
- Tokyo Women's Medical University
- College of Medicine, University of Cincinnati
- College of Medicine, Seoul National University
- Tongji Medical College, Huazhong University of Science and Technology
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Gallbladder and Bile Duct Disorders
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Health Sciences › Medicine › Epidemiology › Urinary Tract Infections Management
- Keywords
- Tokyo Guidelines 2018, acute cholangitis, cholecystitis, antimicrobial therapy, empirical antibiotic therapy, community-acquired infections, nosocomial infections, antimicrobial resistance, antibiogram, antibiotic de-escalation, antibiotic duration, antibiotic prophylaxis, endoscopic retrograde cholangiopancreatography
- MeSH terms
- Clinical Decision-Making, Acute Disease, Anti-Bacterial Agents, Cholangiopancreatography, Endoscopic Retrograde, Cholangitis, Female, Humans, Male, Tokyo, Treatment Outcome, Practice Guidelines as Topic, Community-Acquired Infections, Cholecystitis, Acute
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