- Blood cultures prior to starting antibiotics.
- Intra-operative or percutaneous drainage samples (if applicable)
Biliary sepsis (acute cholecystitis/cholangitis)
- Infection may be complicated by abscess or perforation
Amoxicillin 1g every 8 hours IV
AND
Gentamicin (use NHS Lothian Calculator located AMT intranet page)
AND
Metronidazole 400mg every 8 hours orally(500mg every 8 hours IV if oral route unavailable)
Penicillin allergy or known MRSA carriage:
Vancomycin IV (use NHS Lothian Calculator located AMT intranet page) - target trough level 10-15mg/L
AND
Gentamicin (use NHS Lothian Calculator located AMT intranet page)
AND
Metronidazole 400mg every 8 hours orally (500mg every 8 hours IV if oral route unavailable)
- Review IV antibiotics within 48 hours OR as soon as imaging results available
- In the absence of complications, consider early IV to oral switch
Preferred:
Co-trimoxazole 960mg every 12 hours orally
PLUS
Metronidazole 400mg every 8 hours orally
Alternative:
Co-amoxiclav 625mg every 8 hours orally (Suitable for those ≤ 65 years old with a low risk of C.diff infection. See Prevention, diagnosis and management of CDI.)
Recommended total duration
- Uncomplicated infection with adequate source control: no antibiotics required post operatively
- Uncomplicated infection managed conservatively or prior to delayed cholecystectomy: 5 days total (IV + PO)
- Complicated infection with adequate source control (either surgery or radiological drainage: 5 days total (IV + PO) post source control
Longer courses may be required for complex patients or abscess not amenable to drainage. Discuss with microbiology.