caa a22 4500 445888253 CHVBK 20180317145606.0 cr unu---uuuuu 170323e20111201xx s 000 0 eng 10.1007/s00535-011-0451-5 doi (NATIONALLICENCE)springer-10.1007/s00535-011-0451-5 Fever-based antibiotic therapy for acute cholangitis following successful endoscopic biliary drainage [Elektronische Daten] [Hirofumi Kogure, Takeshi Tsujino, Keisuke Yamamoto, Suguru Mizuno, Yoko Yashima, Hiroshi Yagioka, Kazumichi Kawakubo, Takashi Sasaki, Yousuke Nakai, Kenji Hirano, Naoki Sasahira, Hiroyuki Isayama, Minoru Tada, Takao Kawabe, Masao Omata, Sohei Harada, Yasuo Ota, Kazuhiko Koike] Background: The current management of acute cholangitis consists of antibiotic therapy in combination with biliary drainage. However, the optimal duration of antibiotic therapy after the resolution of clinical symptoms by biliary drainage is unclear. We aimed to evaluate whether discontinuing antibiotic therapy for acute cholangitis immediately after the resolution of clinical symptoms, achieved by endoscopic biliary drainage, was safe and effective. Methods: This prospective study included patients with moderate and severe acute cholangitis. Cefmetazole sodium and meropenem hydrate were used as initial antibiotic therapy for patients with moderate and severe acute cholangitis, respectively. All patients underwent endoscopic biliary drainage within 24h of diagnosis. When the body temperature of <37°C was maintained for 24h, administration of antibiotics was stopped. The primary endpoint was the recurrence of acute cholangitis within 3days after the withdrawal of antibiotic therapy. Results: Eighteen patients were subjected to the final analysis. The causes of cholangitis were bile duct stone (n=17) and bile duct cancer (n=1). The severity of acute cholangitis was moderate in 14 patients and severe in 4. Body temperature of <37°C was achieved in all patients after a median of 2days (range 1-6) following endoscopic biliary drainage. Antibiotic therapy was administered for a median duration of 3days (range 2-7). None of the patients developed recurrent cholangitis within 3days after the withdrawal of antibiotics. Conclusions: Fever-based antibiotic therapy for acute cholangitis is safe and effective when resolution of fever is achieved following endoscopic biliary drainage. Springer, 2011 Acute cholangitis nationallicence Endoscopic biliary drainage nationallicence Antibiotic therapy nationallicence CRP : C-reactive protein nationallicence CMZ : Cefmetazole sodium nationallicence MEPM : Meropenem hydrate nationallicence ERCP : Endoscopic retrograde cholangiopancreatography nationallicence ENBD : Endoscopic nasobiliary drainage nationallicence EST : Endoscopic sphincterotomy nationallicence EPBD : Endoscopic papillary balloon dilation nationallicence WBC : White blood cell nationallicence SD : Standard deviation nationallicence ASA : American Society of Anesthesiologists nationallicence AZT : Aztreonam nationallicence Kogure Hirofumi Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan aut Tsujino Takeshi Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan aut Yamamoto Keisuke Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan aut Mizuno Suguru Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan aut Yashima Yoko Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan aut Yagioka Hiroshi Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan aut Kawakubo Kazumichi Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan aut Sasaki Takashi Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan aut Nakai Yousuke Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan aut Hirano Kenji Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan aut Sasahira Naoki Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan aut Isayama Hiroyuki Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan aut Tada Minoru Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan aut Kawabe Takao Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan aut Omata Masao Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan aut Harada Sohei Department of Infectious Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan aut Ota Yasuo Department of Infectious Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan aut Koike Kazuhiko Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan aut Journal of Gastroenterology Springer Japan 46/12(2011-12-01), 1411-1417 0944-1174 46:12<1411 2011 46 535 https://doi.org/10.1007/s00535-011-0451-5 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s00535-011-0451-5 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Kogure Hirofumi Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan aut NATIONALLICENCE 700 1- Tsujino Takeshi Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan aut NATIONALLICENCE 700 1- Yamamoto Keisuke Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan aut NATIONALLICENCE 700 1- Mizuno Suguru Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan aut NATIONALLICENCE 700 1- Yashima Yoko Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan aut NATIONALLICENCE 700 1- Yagioka Hiroshi Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan aut NATIONALLICENCE 700 1- Kawakubo Kazumichi Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan aut NATIONALLICENCE 700 1- Sasaki Takashi Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan aut NATIONALLICENCE 700 1- Nakai Yousuke Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan aut NATIONALLICENCE 700 1- Hirano Kenji Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan aut NATIONALLICENCE 700 1- Sasahira Naoki Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan aut NATIONALLICENCE 700 1- Isayama Hiroyuki Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan aut NATIONALLICENCE 700 1- Tada Minoru Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan aut NATIONALLICENCE 700 1- Kawabe Takao Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan aut NATIONALLICENCE 700 1- Omata Masao Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan aut NATIONALLICENCE 700 1- Harada Sohei Department of Infectious Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan aut NATIONALLICENCE 700 1- Ota Yasuo Department of Infectious Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan aut NATIONALLICENCE 700 1- Koike Kazuhiko Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan aut NATIONALLICENCE 773 0- Journal of Gastroenterology Springer Japan 46/12(2011-12-01), 1411-1417 0944-1174 46:12<1411 2011 46 535 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer