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Role of Antibiotic Therapy in Mild Acute Calculus Cholecystitis: A Prospective Randomized Controlled Trial

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Abstract

Background

Current recommendations for treating acute calculus cholecystitis include the use of intravenous antibiotics, although these recommendations were never tested scientifically. The aim of this study was to evaluate the role of intravenous antibiotic therapy in patients with mild acute calculus cholecystitis.

Methods

In this prospective, randomized controlled trial, 84 patients with a diagnosis of mild acute calculus cholecystitis were randomly assigned to supportive treatment only or supportive treatment with intravenous antibiotic treatment (42 patients in each arm). Patients were followed through their index admission and until delayed laparoscopic cholecystectomy was performed.

Results

The two study groups did not differ in their demographic data or in the clinical presentation and disease severity. Analysis was conducted on the intent-to-treat basis. Patients in the intravenous antibiotics arm resumed a liquid diet earlier (1.7 vs. 2.2 days, p = 0.02) but did not significantly differ in resumption of regular diet (2.8 vs. 3.2 days, p = 0.16) or hospital length of stay (LOS) (3.9 vs. 3.8 days, p = 0.89). Patients in the intravenous antibiotics arm had rates of percutaneous cholecystostomy tube placement (12 vs. 5 %, p = 0.43), readmissions (19 vs. 13 %, p = 0.73), and perioperative course similar to those not receiving antibiotics. The overall hospital LOS, including initial hospitalization and subsequent cholecystectomy, was similar for both groups (5.6 vs. 5.1 days, p = 0.29). Eight (19 %) patients in the supportive arm were crossed over to the intravenous antibiotic arm during the index admission.

Conclusions

Intravenous antibiotic treatment does not improve the hospital course or early outcome in most of the patients with mild acute calculus cholecystitis.

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Authors and Affiliations

  1. Department of Surgery, Hadassah-Hebrew University Medical Center, Mount Scopus, P.O.B. 24035, 91240, Jerusalem, Israel

    Haggi Mazeh, Ido Mizrahi, Herbert R. Freund & Ahmed Eid

  2. School of Public Health, Hadassah-Hebrew University Medical School, Jerusalem, Israel

    Uri Dior

  3. Department of Radiology, Hadassah-Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel

    Natalia Simanovsky

  4. Department of Infectious Diseases, Hadassah-Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel

    Mervyn Shapiro

  5. Department of Infectious Diseases, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

    Mervyn Shapiro

  6. Hebrew University-Hadassah Medical School, Jerusalem, Israel

    Haggi Mazeh, Ido Mizrahi, Natalia Simanovsky, Mervyn Shapiro, Herbert R. Freund & Ahmed Eid

Authors
  1. Haggi Mazeh
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  2. Ido Mizrahi
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  3. Uri Dior
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  4. Natalia Simanovsky
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  6. Herbert R. Freund
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  7. Ahmed Eid
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Correspondence to Haggi Mazeh.

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Mazeh, H., Mizrahi, I., Dior, U. et al. Role of Antibiotic Therapy in Mild Acute Calculus Cholecystitis: A Prospective Randomized Controlled Trial. World J Surg 36, 1750–1759 (2012). https://doi.org/10.1007/s00268-012-1572-6

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  • DOI: https://doi.org/10.1007/s00268-012-1572-6

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