Conservative Pharmacologic Management of Acute Cholecystitis: Focus on Drug Choice and Outcomes
Keywords:
acute cholecystitis, conservative management, antibiotics, analgesia, Tokyo Guidelines, gallstones, biliary infection, antimicrobial stewardshipAbstract
Conservative treatment of acute cholecystitis combines hemodynamic support, targeted antibiotics, and analgesia to control sepsis and limit local inflammation before or instead of surgery. Evidence from randomized and observational studies indicates that conservative management during the index admission succeeds in most patients with mild-to-moderate calculous cholecystitis, although a subset will later experience recurrent gallstone-related events. Guideline frameworks such as the Tokyo Guidelines 2018 stratify patients by severity and define antibiotic regimens, duration, and indications for gallbladder drainage. This article reviews key components of conservative management, compares commonly used antibiotic regimens, and summarizes data on treatment success, complications, and recurrence. A comparative table and bar plot illustrate spectrum of activity and semi-quantitative evidence strength for five representative regimens. Practical considerations for tailoring therapy, including local ecology, biliary penetration, and stewardship, are discussed together with research gaps regarding minimal effective antibiotic exposure and optimal nonoperative strategies.
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