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Tokyo Guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis
Harumi Gomi1, Joseph S Solomkin2, David Schlossberg3
1Center for Global Health, Mito Kyodo General Hospital, University of Tsukuba, Ibaraki, Japan.
Journal of Hepato-Biliary-Pancreatic Sciences
|November 2, 2017
Summary
The Tokyo Guidelines 2018 (TG18) update antimicrobial recommendations for acute cholangitis and cholecystitis, emphasizing prudent use and revised therapy durations. Prophylactic antibiotics for ERCP are no longer advised.
Area of Science:
- Gastroenterology and Hepatology
- Infectious Diseases
- Clinical Practice Guidelines
Background:
- Antimicrobial therapy is crucial for acute cholangitis and cholecystitis.
- The Tokyo Guidelines 2018 (TG18) offer updated empirical antimicrobial recommendations.
- Guidelines address community-acquired and healthcare-associated infections.
Discussion:
- TG18 categorizes antimicrobial agents by class and severity grade (I-III) for different clinical settings.
- Monitoring local antibiograms is vital due to rising antimicrobial resistance.
- Prudent antimicrobial use, including de-escalation and early termination, is emphasized.
Key Insights:
- TG18 systematically reviews antimicrobial therapy duration for acute cholangitis and cholecystitis.
- Prophylactic antimicrobial use for elective ERCP is no longer recommended.
- Updated guidelines support evidence-based antimicrobial stewardship.
Outlook:
- Future updates will likely incorporate evolving resistance patterns.
- Continued research on optimal antimicrobial strategies is essential.
- Dissemination of TG18 recommendations aims to improve patient outcomes.
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