Tokyo Guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis

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  • Harumi Gomi
    Center for Global Health Mito Kyodo General Hospital University of Tsukuba Ibaraki Japan
  • Joseph S. Solomkin
    Department of Surgery University of Cincinnati College of Medicine Cincinnati OH USA
  • David Schlossberg
    Lewis Katz School of Medicine at Temple University Philadelphia PA USA
  • Kohji Okamoto
    Department of Surgery Center for Gastroenterology and Liver Disease Kitakyushu City Yahata Hospital Fukuoka Japan
  • Tadahiro Takada
    Department of Surgery Teikyo University School of Medicine Tokyo Japan
  • Steven M. Strasberg
    Section of HPB Surgery Washington University in St. Louis St. Louis MO USA
  • Tomohiko Ukai
    Department of Family Medicine Mie Prefectural Ichishi Hospital Mie Japan
  • Itaru Endo
    Department of Gastroenterological Surgery Yokohama City University Graduate School of Medicine Kanagawa Japan
  • Yukio Iwashita
    Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan
  • Taizo Hibi
    Department of Surgery Keio University School of Medicine Tokyo Japan
  • Henry A. Pitt
    Lewis Katz School of Medicine at Temple University Philadelphia PA USA
  • Naohisa Matsunaga
    Department of Infection Control and Prevention Teikyo University Tokyo Japan
  • Yoriyuki Takamori
    Department of Internal Medicine Teikyo University School of Medicine Tokyo Japan
  • Akiko Umezawa
    Minimally Invasive Surgery Center Yotsuya Medical Cube Tokyo Japan
  • Koji Asai
    Department of Surgery Toho University Ohashi Medical Center Tokyo Japan
  • Kenji Suzuki
    Department of Surgery Fujinomiya City General Hospital Shizuoka Japan
  • Ho‐Seong Han
    Department of Surgery Seoul National University Bundang Hospital Seoul National University College of Medicine Seoul Korea
  • Tsann‐Long Hwang
    Division of General Surgery Linkou Chang Gung Memorial Hospital Taoyuan Taiwan
  • Yasuhisa Mori
    Department of Surgery and Oncology Graduate School of Medical Sciences Kyushu University Fukuoka Japan
  • Yoo‐Seok Yoon
    Department of Surgery Seoul National University Bundang Hospital Seoul National University College of Medicine Seoul Korea
  • Wayne Shih‐Wei Huang
    Department of Surgery Show Chwan Memorial Hospital Changhua Taiwan
  • Giulio Belli
    Department of General and HPB Surgery Loreto Nuovo Hospital Naples Italy
  • Christos Dervenis
    First Department of Surgery Agia Olga Hospital Athens Greece
  • Masamichi Yokoe
    Department of General Internal Medicine Japanese Red Cross Nagoya Daini Hospital Aichi Japan
  • Seiki Kiriyama
    Department of Gastroenterology Ogaki Municipal Hospital Gifu Japan
  • Takao Itoi
    Department of Gastroenterology and Hepatology Tokyo Medical University Hospital Tokyo Japan
  • Palepu Jagannath
    Department of Surgical Oncology Lilavati Hospital and Research Centre Mumbai India
  • O. James Garden
    Clinical Surgery University of Edinburgh Edinburgh UK
  • Fumihiko Miura
    Department of Surgery Teikyo University School of Medicine Tokyo Japan
  • Eduardo de Santibañes
    Department of Surgery, Hospital Italiano University of Buenos Aires Buenos Aires Argentina
  • Satoru Shikata
    Mie Prefectural Ichishi Hospital Mie Japan
  • Yoshinori Noguchi
    Department of General Internal Medicine Japanese Red Cross Nagoya Daini Hospital Aichi Japan
  • Keita Wada
    Department of Surgery Teikyo University School of Medicine Tokyo Japan
  • Goro Honda
    Department of Surgery Tokyo Metropolitan Komagome Hospital Tokyo Japan
  • Avinash Nivritti Supe
    Department of Surgical Gastroenterology Seth G S Medical College and K E M Hospital Mumbai India
  • Masahiro Yoshida
    Department of Hemodialysis and Surgery Ichikawa Hospital International University of Health and Welfare Chiba Japan
  • Toshihiko Mayumi
    Department of Emergency Medicine School of Medicine University of Occupational and Environmental Health Fukuoka Japan
  • Dirk J. Gouma
    Department of Surgery Academic Medical Center Amsterdam The Netherlands
  • Daniel J. Deziel
    Department of Surgery Rush University Medical Center Chicago IL USA
  • Kui‐Hin Liau
    Liau KH Consulting PL Mt Elizabeth Novena Hospital, Singapore Yong Loo Lin School of Medicine National University of Singapore Singapore
  • Miin‐Fu Chen
    Division of General Surgery Linkou Chang Gung Memorial Hospital Taoyuan Taiwan
  • Keng‐Hao Liu
    Division of General Surgery Linkou Chang Gung Memorial Hospital Taoyuan Taiwan
  • Cheng‐Hsi Su
    Department of Surgery Cheng Hsin General Hospital Taipei Taiwan
  • Angus C. W. Chan
    Surgery Centre Department of Surgery Hong Kong Sanatorium and Hospital Hong Kong Hong Kong
  • Dong‐Sup Yoon
    Department of Surgery Yonsei University Gangnam Severance Hospital Seoul Korea
  • In‐Seok Choi
    Department of Surgery Konyang University Hospital Daejeon Korea
  • Eduard Jonas
    Surgical Gastroenterology/Hepatopancreatobiliary Unit University of Cape Town and Groote Schuur Hospital Cape Town South Africa
  • Xiao‐Ping Chen
    Hepatic Surgery Centre Department of Surgery Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China
  • Sheung Tat Fan
    Liver Surgery Centre Hong Kong Sanatorium and Hospital Hong Kong Hong Kong
  • Chen‐Guo Ker
    Department of Surgery Yuan's General Hospital Kaohsiung Taiwan
  • Mariano Eduardo Giménez
    Chair of General Surgery and Minimal Invasive Surgery “Taquini” University of Buenos Aires, Argentina DAICIM Foundation Buenos Aires Argentina
  • Seigo Kitano
    Oita University Oita Japan
  • Masafumi Inomata
    Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan
  • Shuntaro Mukai
    Department of Gastroenterology and Hepatology Tokyo Medical University Hospital Tokyo Japan
  • Ryota Higuchi
    Department of Surgery Institute of Gastroenterology Tokyo Women's Medical University Tokyo Japan
  • Koichi Hirata
    Department of Surgery JR Sapporo Hospital Hokkaido Japan
  • Kazuo Inui
    Department of Gastroenterology Second Teaching Hospital Fujita Health University Aichi Japan
  • Yoshinobu Sumiyama
    Toho University Tokyo Japan
  • Masakazu Yamamoto
    Department of Surgery Institute of Gastroenterology Tokyo Women's Medical University Tokyo Japan

Description

<jats:title>Abstract</jats:title><jats:p>Antimicrobial therapy is a mainstay of the management for patients with acute cholangitis and/or cholecystitis. The Tokyo Guidelines 2018 (<jats:styled-content style="fixed-case">TG</jats:styled-content>18) 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 <jats:styled-content style="fixed-case">TG</jats:styled-content>18 severity grade I, <jats:styled-content style="fixed-case">II</jats:styled-content>, and <jats:styled-content style="fixed-case">III</jats:styled-content> 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 <jats:styled-content style="fixed-case">TG</jats:styled-content>18 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 <jats:styled-content style="fixed-case">TG</jats:styled-content>18. Free full articles and mobile app of TG18 are available at: <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="http://www.jshbps.jp/modules/en/index.php?content_id=47">http://www.jshbps.jp/modules/en/index.php?content_id=47</jats:ext-link>. Related clinical questions and references are also included.</jats:p>

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