Acute
- Blood cultures recommended (high risk of bacteremia).
- Drainage of obstructed biliary tree is essential (preferably within 48 hours) for therapy of cholangitis.
Usual Pathogens
Enterobacterales
Enterococcus spp
Anaerobes
P. aeruginosa
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Ceftriaxone | 1-2g IV daily | 4-7 days |
| +/- | ||
| Metronidazole IV/PO | 500mg IV/PO q12h |
Alternative
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Amoxicillin-clavulanate | 1.2g IV q6h | 4-7 days |
Penicillin and ceftriaxone allergy
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Ciprofloxacin IV/PO | 400mg IV q12h/500mg PO bid | 4-7 days |
| +/- | ||
| Metronidazole IV/PO | 500mg IV/PO q12h |
Sepsis/Septic shock/Healthcare-associated infection
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Piperacillin-tazobactam | 4.5g IV q8h or | 4-7 days |
| 3.375g IV q6h | ||
| Penicillin allergy or previous ceftriaxone-resistant Gram negative organism | ||
| Meropenem | 500mg IV q6h | 4-7 days |
| If known VRE colonization, add: | ||
| Linezolid | 600mg IV/PO q12h | 4-7 days |
Penicillin and carbapenem allergy
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Vancomycin | 15mg/kg IV q12h | 4-7 days |
| + | ||
| [Ceftriaxone | 1-2g IV daily | |
| or | ||
| Ciprofloxacin IV/PO] | 400mg IV q12h/500-750mg PO bid | |
| +/- | ||
| Metronidazole IV/PO | 500mg IV/PO q12h |