Systematic review of antibiotic treatment for acute calculous cholecystitis
Background Intravenous antibiotics are frequently used in the initial management of acute calculous cholecystitis (ACC), although supportive care alone preceding delayed elective cholecystectomy may be sufficient. This systematic review assessed the success rate of antibiotics in the treatment of AC...
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| Published in | British journal of surgery Vol. 103; no. 7; pp. 797 - 811 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Chichester, UK
John Wiley & Sons, Ltd
01.06.2016
Oxford University Press |
| Subjects | |
| Online Access | Get full text |
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| Abstract | Background
Intravenous antibiotics are frequently used in the initial management of acute calculous cholecystitis (ACC), although supportive care alone preceding delayed elective cholecystectomy may be sufficient. This systematic review assessed the success rate of antibiotics in the treatment of ACC.
Methods
A systematic search of MEDLINE, Embase and Cochrane Library databases was performed. Primary outcomes were the need for emergency intervention and recurrence of ACC after initial non‐operative management of ACC. Risk of bias was assessed. Pooled event rates were calculated using a random‐effects model.
Results
Twelve randomized trials, four prospective and ten retrospective studies were included. Only one trial including 84 patients compared treatment with antibiotics to that with no antibiotics; there was no significant difference between the two groups in terms of length of hospital stay and morbidity. Some 5830 patients with ACC were included, of whom 2997 had early cholecystectomy, 2791 received initial antibiotic treatment, and 42 were treated conservatively. Risk of bias was high in most studies, and all but three studies had a low level of evidence. For randomized studies, pooled event rates were 15 (95 per cent c.i. 10 to 22) per cent for the need for emergency intervention and 10 (5 to 20) per cent for recurrence of ACC. The pooled event rate for both outcomes combined was 20 (13 to 30) per cent.
Conclusion
Antibiotics are not indicated for the conservative management of ACC or in patients scheduled for cholecystectomy.
Antibiotics not indicated |
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| AbstractList | Intravenous antibiotics are frequently used in the initial management of acute calculous cholecystitis (ACC), although supportive care alone preceding delayed elective cholecystectomy may be sufficient. This systematic review assessed the success rate of antibiotics in the treatment of ACC.
A systematic search of MEDLINE, Embase and Cochrane Library databases was performed. Primary outcomes were the need for emergency intervention and recurrence of ACC after initial non-operative management of ACC. Risk of bias was assessed. Pooled event rates were calculated using a random-effects model.
Twelve randomized trials, four prospective and ten retrospective studies were included. Only one trial including 84 patients compared treatment with antibiotics to that with no antibiotics; there was no significant difference between the two groups in terms of length of hospital stay and morbidity. Some 5830 patients with ACC were included, of whom 2997 had early cholecystectomy, 2791 received initial antibiotic treatment, and 42 were treated conservatively. Risk of bias was high in most studies, and all but three studies had a low level of evidence. For randomized studies, pooled event rates were 15 (95 per cent c.i. 10 to 22) per cent for the need for emergency intervention and 10 (5 to 20) per cent for recurrence of ACC. The pooled event rate for both outcomes combined was 20 (13 to 30) per cent.
Antibiotics are not indicated for the conservative management of ACC or in patients scheduled for cholecystectomy. BACKGROUNDIntravenous antibiotics are frequently used in the initial management of acute calculous cholecystitis (ACC), although supportive care alone preceding delayed elective cholecystectomy may be sufficient. This systematic review assessed the success rate of antibiotics in the treatment of ACC.METHODSA systematic search of MEDLINE, Embase and Cochrane Library databases was performed. Primary outcomes were the need for emergency intervention and recurrence of ACC after initial non-operative management of ACC. Risk of bias was assessed. Pooled event rates were calculated using a random-effects model.RESULTSTwelve randomized trials, four prospective and ten retrospective studies were included. Only one trial including 84 patients compared treatment with antibiotics to that with no antibiotics; there was no significant difference between the two groups in terms of length of hospital stay and morbidity. Some 5830 patients with ACC were included, of whom 2997 had early cholecystectomy, 2791 received initial antibiotic treatment, and 42 were treated conservatively. Risk of bias was high in most studies, and all but three studies had a low level of evidence. For randomized studies, pooled event rates were 15 (95 per cent c.i. 10 to 22) per cent for the need for emergency intervention and 10 (5 to 20) per cent for recurrence of ACC. The pooled event rate for both outcomes combined was 20 (13 to 30) per cent.CONCLUSIONAntibiotics are not indicated for the conservative management of ACC or in patients scheduled for cholecystectomy. Background Intravenous antibiotics are frequently used in the initial management of acute calculous cholecystitis (ACC), although supportive care alone preceding delayed elective cholecystectomy may be sufficient. This systematic review assessed the success rate of antibiotics in the treatment of ACC. Methods A systematic search of MEDLINE, Embase and Cochrane Library databases was performed. Primary outcomes were the need for emergency intervention and recurrence of ACC after initial non-operative management of ACC. Risk of bias was assessed. Pooled event rates were calculated using a random-effects model. Results Twelve randomized trials, four prospective and ten retrospective studies were included. Only one trial including 84 patients compared treatment with antibiotics to that with no antibiotics; there was no significant difference between the two groups in terms of length of hospital stay and morbidity. Some 5830 patients with ACC were included, of whom 2997 had early cholecystectomy, 2791 received initial antibiotic treatment, and 42 were treated conservatively. Risk of bias was high in most studies, and all but three studies had a low level of evidence. For randomized studies, pooled event rates were 15 (95 per cent c.i. 10 to 22) per cent for the need for emergency intervention and 10 (5 to 20) per cent for recurrence of ACC. The pooled event rate for both outcomes combined was 20 (13 to 30) per cent. Conclusion Antibiotics are not indicated for the conservative management of ACC or in patients scheduled for cholecystectomy. Antibiotics not indicated Background Intravenous antibiotics are frequently used in the initial management of acute calculous cholecystitis (ACC), although supportive care alone preceding delayed elective cholecystectomy may be sufficient. This systematic review assessed the success rate of antibiotics in the treatment of ACC. Methods A systematic search of MEDLINE, Embase and Cochrane Library databases was performed. Primary outcomes were the need for emergency intervention and recurrence of ACC after initial non‐operative management of ACC. Risk of bias was assessed. Pooled event rates were calculated using a random‐effects model. Results Twelve randomized trials, four prospective and ten retrospective studies were included. Only one trial including 84 patients compared treatment with antibiotics to that with no antibiotics; there was no significant difference between the two groups in terms of length of hospital stay and morbidity. Some 5830 patients with ACC were included, of whom 2997 had early cholecystectomy, 2791 received initial antibiotic treatment, and 42 were treated conservatively. Risk of bias was high in most studies, and all but three studies had a low level of evidence. For randomized studies, pooled event rates were 15 (95 per cent c.i. 10 to 22) per cent for the need for emergency intervention and 10 (5 to 20) per cent for recurrence of ACC. The pooled event rate for both outcomes combined was 20 (13 to 30) per cent. Conclusion Antibiotics are not indicated for the conservative management of ACC or in patients scheduled for cholecystectomy. Antibiotics not indicated |
| Author | Hugh, T. J. de Reuver, P. R. Boermeester, M. A. van Dijk, A. H. Tasma, T. N. van Dieren, S. |
| Author_xml | – sequence: 1 givenname: A. H. surname: van Dijk fullname: van Dijk, A. H. email: a.h.vandijk@amc.uva.nl organization: Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands – sequence: 2 givenname: P. R. surname: de Reuver fullname: de Reuver, P. R. organization: Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands – sequence: 3 givenname: T. N. surname: Tasma fullname: Tasma, T. N. organization: Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands – sequence: 4 givenname: S. surname: van Dieren fullname: van Dieren, S. organization: Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands – sequence: 5 givenname: T. J. surname: Hugh fullname: Hugh, T. J. organization: Upper Gastrointestinal Surgery Unit, Royal North Shore Hospital, University of Sydney, New South Wales, Sydney, Australia – sequence: 6 givenname: M. A. surname: Boermeester fullname: Boermeester, M. A. organization: Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands |
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| CitedBy_id | crossref_primary_10_1016_j_ciresp_2020_04_031 crossref_primary_10_1016_j_hpb_2018_11_007 crossref_primary_10_3748_wjg_v24_i43_4870 crossref_primary_10_1002_14651858_CD013646 crossref_primary_10_1016_j_ciresp_2020_04_017 crossref_primary_10_1590_1806_9282_20210560 crossref_primary_10_1177_1553350619835347 crossref_primary_10_1002_jhbp_1237 crossref_primary_10_1128_AAC_00527_17 crossref_primary_10_1097_MD_0000000000020101 crossref_primary_10_47820_recima21_v5i3_4974 crossref_primary_10_1007_s00268_023_06968_9 crossref_primary_10_1007_s00464_018_6498_0 crossref_primary_10_1080_08998280_2022_2153353 crossref_primary_10_1515_cclm_2023_0195 crossref_primary_10_35366_112922 crossref_primary_10_36106_ijsr_2005775 crossref_primary_10_1111_ans_15603 crossref_primary_10_1007_s10096_023_04713_7 crossref_primary_10_1007_s00268_022_06772_x crossref_primary_10_3390_diagnostics14040403 crossref_primary_10_1111_1744_1633_12300 crossref_primary_10_1016_j_cireng_2021_03_013 crossref_primary_10_1016_j_surg_2018_01_014 crossref_primary_10_23736_S0394_9508_21_05282_7 crossref_primary_10_1016_j_cireng_2020_09_015 crossref_primary_10_5937_Halo1901046K crossref_primary_10_3390_antibiotics12030482 crossref_primary_10_22141_2224_0586_20_2_2024_1668 crossref_primary_10_17352_2455_2968_000080 |
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| Copyright | 2016 BJS Society Ltd Published by John Wiley & Sons Ltd 2016 BJS Society Ltd Published by John Wiley & Sons Ltd. Copyright © 2016 BJS Society Ltd. Published by John Wiley & Sons, Ltd. |
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| Notes | Appendix S1 Systemic literature search Table S1 Characteristics of excluded studies Table S2 Definition of acute calculous cholecystitis in included studies Fig. S1 Funnel plots for the included studies: A need for emergency intervention; B recurrence of acute acalculous cholecystitis; C postoperative morbidity; D patients forgoing elective cholecystectomy Fig. S2 Forest plot of the combination of primary endpoints: recurrence of acute calculous cholecystitis and need for emergency intervention ArticleID:BJS10146 ark:/67375/WNG-F8TDCRX8-T istex:2613AB7B6382C356C7F81619520B45AE71C32641 SourceType-Scholarly Journals-1 ObjectType-Feature-4 ObjectType-Undefined-1 content type line 23 ObjectType-Review-2 ObjectType-Article-3 |
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| PublicationTitle | British journal of surgery |
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Intravenous antibiotics are frequently used in the initial management of acute calculous cholecystitis (ACC), although supportive care alone... Intravenous antibiotics are frequently used in the initial management of acute calculous cholecystitis (ACC), although supportive care alone preceding delayed... Background Intravenous antibiotics are frequently used in the initial management of acute calculous cholecystitis (ACC), although supportive care alone... BACKGROUNDIntravenous antibiotics are frequently used in the initial management of acute calculous cholecystitis (ACC), although supportive care alone... |
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| SubjectTerms | Anti-Bacterial Agents - therapeutic use Antibiotics Cholecystectomy Cholecystitis, Acute - therapy Emergencies Gallbladder diseases Humans Postoperative Complications Preoperative Care Recurrence |
| Title | Systematic review of antibiotic treatment for acute calculous cholecystitis |
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