Antibiosis (antibiotic therapy) [Note: Empiric therapy must be de-escalated (lower dosage, discontinuation of individual agents) as soon as culture results are available; duration of therapy should be kept as short as possible.Choice of antibiotic considering the following criteria: Target organisms, local resistance situation, pharmacokinetics and pharmacodynamics, liver function, previous antibiotic therapy, allergies, and other possible adverse events].
Combination of an antibiotic with a ß-lactamase inhibitor (first-line agent):
Mezlocillin + sulbactam or
Piperacillin + tazobactam
3rd generation cephalosporins, e.g. cefotaxime, in combination with metronidazole (second-line agent)Note: Monotherapy with 3rd generation cephalosporins is critically questioned due to the high incidence (frequency of new cases) of enterococcal-associated cholangitis. In almost one-third of cases, the germs are resistant to cephalosporins.
If Pseudomonas infection is suspected: piperacillin in combination with an aminoglycoside, e.g. tobramycin; strict control of aminoglycoside and creatinine concentrations!
Duration of therapy: until complete reopening of the bile ducts.
If necessary, butylscopolamine (parasympatholytic); rectal (“into the rectum”) or parenteral (“bypassing the intestine”) administration prefer!
In addition to drug therapy, food abstinence (abstaining from food) should be observed for at least 24 h, so as not to stimulate digestion and bile flow; then low-fat diet.
