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Cholangitis, Neutrophilic (view source)
Revision as of 15:51, 20 August 2009
, 15:51, 20 August 2009→Treatment
**A long course, 4-6 weeks, of an appropriate antibiotic should be given in light of bacterial culture and sensitivity results.
**A long course, 4-6 weeks, of an appropriate antibiotic should be given in light of bacterial culture and sensitivity results.
**Selected antibiotic should be excreted in the bile in active form, and should be active against aerobic and anaerobic intestinal coliforms.
**Selected antibiotic should be excreted in the bile in active form, and should be active against aerobic and anaerobic intestinal coliforms.
**Amoxicillin potentiated with clavulanic acid at 15-20 mg/kg PO q8 hours is a good initial choice.
**Amoxicillin potentiated with clavulanic acid is a good initial choice.
**Metronidazole may be added to extend the spectrum of anaerobes and coliforms.
**Metronidazole may be added to extend the spectrum of anaerobes and coliforms.
*Surgery is warranted if discrete choleliths or complete biliary obstruction is identified.
*Surgery is warranted if discrete choleliths or complete biliary obstruction is identified.
**In cases of complete extrahepatic biliary obstruction, surgical decompression and cholecystoduodenostomy or cholecystojejunostomy should be performed.
**In cases of complete extrahepatic biliary obstruction, surgical decompression and cholecystoduodenostomy or cholecystojejunostomy should be performed.
*Ursodeoxycholic acid at 15 mg/kg q24 hours PO may be given.
*Ursodeoxycholic acid may be given.
**It has hepatoprotective (anti-inflammatory, immunomodulatory and antifibrotic effects) properties and choleretic effect. The latter promotes increased fluidity of biliary secretions for treating or preventing sludging.
**It has hepatoprotective (anti-inflammatory, immunomodulatory and antifibrotic effects) properties and choleretic effect. The latter promotes increased fluidity of biliary secretions for treating or preventing sludging.
*Aggressive supportive care is required due to severe illness.
*Aggressive supportive care is required due to severe illness.