Describe general principles.
Important considerations
Obtain blood cultures prior to administering antibiotics, especially in patients with severe biliary infection.
Obtain bile cultures at the beginning of any drainage procedure.
Tailor antibiotic therapy to sensitivity reports as early as possible. [28]
Switch to oral antibiotics, if feasible, once improvement is evident. [34]
Required coverage
Gram-negative coverage: Escherichia coli (most common), Klebsiella spp., Enterobacter spp., Pseudomonas spp.
Anaerobic coverage is recommended if biliary-enteric anastomosis is suspected or identified.
Consider Enterococcus spp. coverage in grade III community-acquired and healthcare-associated infection.
Choice of empiric antibiotic: should be determined by the following parameters
Community-acquired or healthcare-associated infection
Severity of infection (see “Severity grading of acute cholecystitis” or “Severity grading of acute cholangitis” for details on grading)
Local resistance patterns (local antibiogram)
If a biliary-enteric anastomosis is suspected
Empiric regimen.
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