Changes

**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 at 15-20 mg/kg PO q8 hours is a good initial choice.

**Amoxicillin potentiated with clavulanic acid at 15-20 mg/kg PO q8 hours is a good initial choice.

**Metronidazol 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.