Tokyo Guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis

Harumi Gomi¹, Joseph S Solomkin², David Schlossberg³, Kohji Okamoto⁴, Tadahiro Takada⁵, Steven M Strasberg⁶, Tomohiko Ukai⁷, Itaru Endo⁸, Yukio Iwashita⁹, Taizo Hibi¹⁰, Henry A Pitt³, Naohisa Matsunaga¹¹, Yoriyuki Takamori¹², Akiko Umezawa¹³, Koji Asai¹⁴, Kenji Suzuki¹⁵, Ho-Seong Han¹⁶, Tsann-Long Hwang¹⁷, Yasuhisa Mori¹⁸, Yoo-Seok Yoon¹⁶, Wayne Shih-Wei Huang¹⁹, Giulio Belli²⁰, Christos Dervenis²¹, Masamichi Yokoe²², Seiki Kiriyama²³, Takao Itoi²⁴, Palepu Jagannath²⁵, O James Garden²⁶, Fumihiko Miura⁵, Eduardo de Santibañes²⁷, Satoru Shikata²⁸, Yoshinori Noguchi²², Keita Wada⁵, Goro Honda²⁹, Avinash Nivritti Supe³⁰, Masahiro Yoshida^{31

32}, Toshihiko Mayumi³³, Dirk J Gouma³⁴, Daniel J Deziel³⁵, Kui-Hin Liau³⁶, Miin-Fu Chen¹⁷, Keng-Hao Liu¹⁷, Cheng-Hsi Su³⁷, Angus C W Chan³⁸, Dong-Sup Yoon³⁹, In-Seok Choi⁴⁰, Eduard Jonas⁴¹, Xiao-Ping Chen⁴², Sheung Tat Fan⁴³, Chen-Guo Ker⁴⁴, Mariano Eduardo Giménez⁴⁵, Seigo Kitano⁴⁶, Masafumi Inomata⁹, Shuntaro Mukai²⁴, Ryota Higuchi⁴⁷, Koichi Hirata⁴⁸, Kazuo Inui⁴⁹, Yoshinobu Sumiyama⁵⁰, Masakazu Yamamoto⁴⁷

Affiliations

¹ Center for Global Health, Mito Kyodo General Hospital, University of Tsukuba, Ibaraki, Japan.
² Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
³ Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
⁴ Department of Surgery, Center for Gastroenterology and Liver Disease, Kitakyushu City Yahata Hospital, Fukuoka, Japan.
⁵ Department of Surgery, Teikyo University, School of Medicine, Tokyo, Japan.
⁶ Section of HPB Surgery, Washington University in St. Louis, St. Louis, MO, USA.
⁷ Department of Family Medicine, Mie Prefectural Ichishi Hospital, Mie, Japan.
⁸ Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Kanagawa, Japan.
⁹ Department of Gastroenterological and Pediatric Surgery, Oita University, Faculty of Medicine, Oita, Japan.
¹⁰ Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
¹¹ Department of Infection Control and Prevention, Teikyo University, Tokyo, Japan.
¹² Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan.
¹³ Minimally Invasive Surgery Center, Yotsuya Medical Cube, Tokyo, Japan.
¹⁴ Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan.
¹⁵ Department of Surgery, Fujinomiya City General Hospital, Shizuoka, Japan.
¹⁶ Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea.
¹⁷ Division of General Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
¹⁸ Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
¹⁹ Department of Surgery, Show Chwan Memorial Hospital, Changhua, Taiwan.
²⁰ Department of General and HPB Surgery, Loreto Nuovo Hospital, Naples, Italy.
²¹ First Department of Surgery, Agia Olga Hospital, Athens, Greece.
²² Department of General Internal Medicine, Japanese Red Cross Nagoya Daini Hospital, Aichi, Japan.
²³ Department of Gastroenterology, Ogaki Municipal Hospital, Gifu, Japan.
²⁴ Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan.
²⁵ Department of Surgical Oncology, Lilavati Hospital and Research Centre, Mumbai, India.
²⁶ Clinical Surgery, University of Edinburgh, Edinburgh, UK.
²⁷ Department of Surgery, Hospital Italiano, University of Buenos Aires, Buenos Aires, Argentina.
²⁸ Mie Prefectural Ichishi Hospital, Mie, Japan.
²⁹ Department of Surgery, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan.
³⁰ Department of Surgical Gastroenterology, Seth G S Medical College and K E M Hospital, Mumbai, India.
³¹ Department of Hemodialysis and Surgery, Ichikawa Hospital, International University of Health and Welfare, Chiba, Japan.
³² Department of EBM and Guidelines, Japan Council for Quality Health Care, Tokyo, Japan.
³³ Department of Emergency Medicine, School of Medicine University of Occupational and Environmental Health, Fukuoka, Japan.
³⁴ Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
³⁵ Department of Surgery, Rush University Medical Center, Chicago, IL, USA.
³⁶ Liau KH Consulting PL, Mt Elizabeth Novena Hospital, Singapore, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
³⁷ Department of Surgery, Cheng Hsin General Hospital, Taipei, Taiwan.
³⁸ Surgery Centre, Department of Surgery, Hong Kong Sanatorium and Hospital, Hong Kong, Hong Kong.
³⁹ Department of Surgery, Yonsei University Gangnam Severance Hospital, Seoul, Korea.
⁴⁰ Department of Surgery, Konyang University Hospital, Daejeon, Korea.
⁴¹ Surgical Gastroenterology/Hepatopancreatobiliary Unit, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.
⁴² Hepatic Surgery Centre, Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
⁴³ Liver Surgery Centre, Hong Kong Sanatorium and Hospital, Hong Kong, Hong Kong.
⁴⁴ Department of Surgery, Yuan's General Hospital, Kaohsiung, Taiwan.
⁴⁵ Chair of General Surgery and Minimal Invasive Surgery "Taquini", University of Buenos Aires, Argentina, DAICIM Foundation, Buenos Aires, Argentina.
⁴⁶ Oita University, Oita, Japan.
⁴⁷ Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
⁴⁸ Department of Surgery, JR Sapporo Hospital, Hokkaido, Japan.
⁴⁹ Department of Gastroenterology, Second Teaching Hospital, Fujita Health University, Aichi, Japan.
⁵⁰ Toho University, Tokyo, Japan.

PMID: 29090866
DOI: 10.1002/jhbp.518

Review

Tokyo Guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis

Harumi Gomi et al. J Hepatobiliary Pancreat Sci. 2018 Jan.

. 2018 Jan;25(1):3-16.

doi: 10.1002/jhbp.518. Epub 2018 Jan 9.

Authors

Affiliations

¹ Center for Global Health, Mito Kyodo General Hospital, University of Tsukuba, Ibaraki, Japan.
² Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
³ Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
⁴ Department of Surgery, Center for Gastroenterology and Liver Disease, Kitakyushu City Yahata Hospital, Fukuoka, Japan.
⁵ Department of Surgery, Teikyo University, School of Medicine, Tokyo, Japan.
⁶ Section of HPB Surgery, Washington University in St. Louis, St. Louis, MO, USA.
⁷ Department of Family Medicine, Mie Prefectural Ichishi Hospital, Mie, Japan.
⁸ Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Kanagawa, Japan.
⁹ Department of Gastroenterological and Pediatric Surgery, Oita University, Faculty of Medicine, Oita, Japan.
¹⁰ Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
¹¹ Department of Infection Control and Prevention, Teikyo University, Tokyo, Japan.
¹² Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan.
¹³ Minimally Invasive Surgery Center, Yotsuya Medical Cube, Tokyo, Japan.
¹⁴ Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan.
¹⁵ Department of Surgery, Fujinomiya City General Hospital, Shizuoka, Japan.
¹⁶ Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea.
¹⁷ Division of General Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
¹⁸ Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
¹⁹ Department of Surgery, Show Chwan Memorial Hospital, Changhua, Taiwan.
²⁰ Department of General and HPB Surgery, Loreto Nuovo Hospital, Naples, Italy.
²¹ First Department of Surgery, Agia Olga Hospital, Athens, Greece.
²² Department of General Internal Medicine, Japanese Red Cross Nagoya Daini Hospital, Aichi, Japan.
²³ Department of Gastroenterology, Ogaki Municipal Hospital, Gifu, Japan.
²⁴ Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan.
²⁵ Department of Surgical Oncology, Lilavati Hospital and Research Centre, Mumbai, India.
²⁶ Clinical Surgery, University of Edinburgh, Edinburgh, UK.
²⁷ Department of Surgery, Hospital Italiano, University of Buenos Aires, Buenos Aires, Argentina.
²⁸ Mie Prefectural Ichishi Hospital, Mie, Japan.
²⁹ Department of Surgery, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan.
³⁰ Department of Surgical Gastroenterology, Seth G S Medical College and K E M Hospital, Mumbai, India.
³¹ Department of Hemodialysis and Surgery, Ichikawa Hospital, International University of Health and Welfare, Chiba, Japan.
³² Department of EBM and Guidelines, Japan Council for Quality Health Care, Tokyo, Japan.
³³ Department of Emergency Medicine, School of Medicine University of Occupational and Environmental Health, Fukuoka, Japan.
³⁴ Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
³⁵ Department of Surgery, Rush University Medical Center, Chicago, IL, USA.
³⁶ Liau KH Consulting PL, Mt Elizabeth Novena Hospital, Singapore, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
³⁷ Department of Surgery, Cheng Hsin General Hospital, Taipei, Taiwan.
³⁸ Surgery Centre, Department of Surgery, Hong Kong Sanatorium and Hospital, Hong Kong, Hong Kong.
³⁹ Department of Surgery, Yonsei University Gangnam Severance Hospital, Seoul, Korea.
⁴⁰ Department of Surgery, Konyang University Hospital, Daejeon, Korea.
⁴¹ Surgical Gastroenterology/Hepatopancreatobiliary Unit, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.
⁴² Hepatic Surgery Centre, Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
⁴³ Liver Surgery Centre, Hong Kong Sanatorium and Hospital, Hong Kong, Hong Kong.
⁴⁴ Department of Surgery, Yuan's General Hospital, Kaohsiung, Taiwan.
⁴⁵ Chair of General Surgery and Minimal Invasive Surgery "Taquini", University of Buenos Aires, Argentina, DAICIM Foundation, Buenos Aires, Argentina.
⁴⁶ Oita University, Oita, Japan.
⁴⁷ Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
⁴⁸ Department of Surgery, JR Sapporo Hospital, Hokkaido, Japan.
⁴⁹ Department of Gastroenterology, Second Teaching Hospital, Fujita Health University, Aichi, Japan.
⁵⁰ Toho University, Tokyo, Japan.

PMID: 29090866
DOI: 10.1002/jhbp.518

Abstract

Antimicrobial therapy is a mainstay of the management for patients with acute cholangitis and/or cholecystitis. The Tokyo Guidelines 2018 (TG18) provides recommendations for the appropriate use of antimicrobials for community-acquired and healthcare-associated infections. The listed agents are for empirical therapy provided before the infecting isolates are identified. Antimicrobial agents are listed by class-definitions and TG18 severity grade I, II, and III subcategorized by clinical settings. In the era of emerging and increasing antimicrobial resistance, monitoring and updating local antibiograms is underscored. Prudent antimicrobial usage and early de-escalation or termination of antimicrobial therapy are now important parts of decision-making. What is new in TG18 is that the duration of antimicrobial therapy for both acute cholangitis and cholecystitis is systematically reviewed. Prophylactic antimicrobial usage for elective endoscopic retrograde cholangiopancreatography is no longer recommended and the section was deleted in TG18. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.

Keywords: Acute cholangitis; Acute cholecystitis; Antimicrobial therapy; Biliary tract infection; Treatment guidelines.

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Comment in

Re: Tokyo Guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis.
Guerin O, Regimbeau JM. Guerin O, et al. J Hepatobiliary Pancreat Sci. 2018 Jun;25(6):E5. doi: 10.1002/jhbp.556. J Hepatobiliary Pancreat Sci. 2018. PMID: 29878694 No abstract available.

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Tokyo Guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis

Affiliations

Tokyo Guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis

Authors

Affiliations

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Medical

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