Reviewed by Jose Lucar, MD, The George Washington University
The best approach to antibiotic choice and duration for patients with acute cholangitis after biliary drainage is still unclear, and data from a recent clinical trial suggest that using blood culture results alone for managing mild-to-moderate acute cholangitis (without organ dysfunction) may be adequate. Researchers in South Korea conducted a multicenter, single-blinded (participants only), randomized controlled trial aimed to investigate the adequacy of relying solely on blood culture results as a guide for antibiotic therapy following biliary drainage in adults with suspected mild-to-moderate acute cholangitis. Participants (n=438) were randomly assigned 1:1 to two groups: the control group (n=215) received antibiotics tailored to blood and bile culture results, and the experimental group (n=213) was treated based on blood culture results only (with 10 participants dropping out). The primary outcome of the study, the rate of organ failure (defined as the presence of shock, acute kidney injury, altered mental status, and acute respiratory distress) was similar in both groups, occurring in 13.0% of participants in the control group and 12.7% in the experimental group (non-significant). Furthermore, mortality occurred in 3.3% of participants in the control group and 2.3% in the experimental group (non-significant), while antibiotic duration (12.8 vs 11.3 days) and duration of hospital stay (14.1 vs 11.0 days) were significantly shorter in the experimental group.
Reference :
Lee TS, Choi JH, Lee JM, et al. A randomized non-inferiority trial investigating antibiotic adjustments based on blood culture in acute cholangitis. Clin Microbiol Infect. Published online January 27, 2025. doi:10.1016/j.cmi.2024.12.039