Biliary sepsis. Reviewing treatment options

Drugs
R Munro, T C Sorrell

Abstract

Bactobilia is a frequent accompaniment of obstruction in the biliary tract, organisms present being normal intestinal aerobes and anaerobes. Bacterial colonisation of the bile may occur asymptomatically, may predispose to infection postoperatively, or may be associated with an attack of acute cholecystitis, occurring secondary to obstruction. The choice of an antimicrobial regimen for biliary infection should take into account the expected antibiotic sensitivities of organisms colonising bile, whether biliary obstruction or bacteraemia is present, and the activity of the antibiotic in bile. Often, high biliary concentrations of an antibiotic cannot be achieved due to obstruction, and in many cases high blood and tissue concentrations are of greater importance. Surgical prophylaxis should be reserved for patients at high risk of bactobilia (e.g. the elderly), when obstruction is present, for immunosuppressed patients, and those with artificial heart valves. A single perioperative dose of a 'first' or 'second generation' cephalosporin, gentamicin, or co-trimoxazole is effective. Antibiotic therapy for acute cholecystitis should be instituted if there is evidence of systemic toxicity, when surgery is to be delayed, or in patients ...Continue Reading

Citations

Mar 11, 2004·Current Treatment Options in Gastroenterology·D. Rohan Jeyarajah
Jan 1, 1994·Journal of Gastroenterology and Hepatology·L C MollisonK Breen
May 20, 2016·European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology·E TajeddinM R Zali
Aug 20, 2005·American Journal of Physiology. Gastrointestinal and Liver Physiology·Kirk J MaurerJames G Fox
Jul 25, 2018·European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology·Siyuan YaoShinji Uemoto

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