Tokyo Guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis.

Published on Jan 1, 2018in Journal of Hepato-biliary-pancreatic Sciences4.16
· DOI :10.1002/JHBP.518
Harumi Gomi13
Estimated H-index: 13
(University of Tsukuba),
Joseph S. Solomkin69
Estimated H-index: 69
(University of Cincinnati Academic Health Center)
+ 56 AuthorsMasakazu Yamamoto63
Estimated H-index: 63
Sources
Abstract
Antimicrobial therapy is a mainstay of the management for patients with acute cholangitis and/or cholecystitis. Tokyo Guidelines 2018 (TG 18) provides recommendations for the appropriate for 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 (ERCP) is no more recommended and the section was deleted in TG 18. This article is protected by copyright. All rights reserved.
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