Shortening antibiotic duration in the treatment of acute cholangitis due to choledocholitiasis with successful biliary duct drainage

Aim The optimal duration of antimicrobial treatment in common bile duct stone associated cholangitis is not well established. We aimed to evaluate the efficacy and safety of short duration vs 14-day antibiotic therapy in acute cholangitis associated with common bile duct stone. Material and methods We divided 278 patients with all stages of acute cholangitis who underwent technically successful ERCP from January 2019 to June 2023 and had positive bile cultures into two groups: antibiotic therapy within two days of ERCP (short-course therapy, SCT; n = 48), and for >3 days (long-course therapy, LCT; n = 230). Results Three recurrence occurred in STC and one recurrence occurred in LTC (p = 0.19). Clinical outcomes were similar between the two groups. The fever duration was similar between mild and moderate cholangitis within the same group and between the 2 groups. Duration of antibiotic therapy in LTC was 4.22 + 1.37 days with 39 (81.3%) needing treatment for < 5 days. Conclusions Short duration antibiotic treatment based on fever resolution of 72 hours was effective and safe in patients with mild to moderate cholangitis due to common bile duct stone.