Antibiotics for acute and chronic cholecystitis: list and treatment regimens

The biliary system is an important part of the digestive tract, and when its function is impaired, the process of digesting food becomes much more complicated. For example, this happens with an inflammatory process in the walls of the gallbladder – cholecystitis. In order to solve the problem and eliminate the inflammation, sometimes conservative therapy is enough, using choleretic, anti-inflammatory, antispasmodic and other drugs. Additionally, antibiotics are prescribed for cholecystitis: such drugs help to significantly speed up the recovery process of patients.

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Indications antibiotics for cholecystitis

Among the many causes that lead to the development of cholecystitis, the infectious nature of the disease occupies a significant place - for example, pathogenic bacteria can enter the biliary system with blood or lymph from other organs, or through the descending or ascending pathway from the digestive tract.

If cholecystitis is calculous - that is, accompanied by the formation of stones in the bladder and/or ducts, then the risk of damage and inflammation of the organ wall increases several times, since stones can mechanically injure tissues.

Treatment of cholecystitis with antibiotics is often mandatory. If the source of the infectious process is not eliminated, the disease may be complicated by the formation of an abscess, suppuration of the bladder and ducts, which may subsequently even lead to death. To prevent this, treatment of cholecystitis should include a set of drugs, including antibiotics.

Direct indications for antibiotic therapy for cholecystitis are:

• severe painful sensations in the liver area, which tend to increase;
• significant increase in temperature (up to +38.5-39°C);
• severe digestive disorders, with diarrhea and repeated vomiting;
• spread of pain throughout the abdomen (so-called “diffuse” pain);
• the presence of other infectious diseases in the patient;
• signs of an infectious process detected as a result of a blood test.

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Antibiotics for cholecystitis and pancreatitis

Antibiotics are needed to get rid of the infection that often contributes to the development of cholecystitis and pancreatitis.

In uncomplicated cases, the doctor prescribes outpatient treatment with antibiotics in tablets. Such tablets may be Tetracycline, Rifampicin, Sigmamycin or Oletetrin, in individual dosages. The average course of antibiotic therapy is 7-10 days.

If surgical treatment was used for cholecystopancreatitis, then an injection course of antibiotics in the form of intramuscular or intravenous drip administration is mandatory. In this case, the use of Kanamycin, Ampicillin or Rifampicin is appropriate.

In case of complicated course of the disease, two antibiotics can be used simultaneously, or the drug can be periodically replaced after determining the resistance of microorganisms.

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Antibiotics for acute cholecystitis

In acute cholecystitis, antibiotics may be useful if peritonitis and empyema of the gallbladder are suspected, as well as in septic complications. The doctor decides which antibiotic is appropriate for acute cholecystitis. Usually, the drug is selected based on the results of bile culture. Also of considerable importance is the property of the selected drug to enter the biliary system and concentrate in the bile to therapeutic levels.

In acute cholecystitis, the most optimal course of therapy is 7-10 days, with intravenous administration of medications being preferred. The use of Cefuroxime, Ceftriaxone, Cefotaxime, and a combination of Amoxicillin and Clavulanate is recommended. A treatment regimen that includes a cephalosporin drug and Metronidazole is often used.

Antibiotics for exacerbation of cholecystitis are used according to similar schemes, with the possibility of prescribing alternative treatment:

• intravenous infusion of Ampicillin 2.0 four times a day;
• intravenous infusion of gentamicin;
• intravenous infusion of Metronidazole 0.5 g four times a day.

A combination of Metronidazole and Ciprofloxacin gives a good effect.

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Antibiotics for chronic cholecystitis

Antibiotics in case of chronic cholecystitis can be prescribed when there are signs of active inflammation in the biliary system. Usually antibiotic therapy is prescribed in the acute stage of the disease, in combination with choleretic and anti-inflammatory drugs:

• Erythromycin 0.25 g four times a day;
• Oleandomycin 500 mg four times a day after meals;
• Rifampicin 0.15 g three times a day;
• Ampicillin 500 mg four to six times a day;
• Oxacillin 500 mg four to six times a day.

The following antibiotics have a pronounced effect: Benzylpenicillin in the form of intramuscular injections, Phenoxymethylpenicillin in tablets, Tetracycline 250 mg 4 times a day, Metacycline 300 mg twice a day, Oletetrin 250 mg four times a day.

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Antibiotics for calculous cholecystitis

Gallstones not only create a mechanical obstruction to the outflow of bile, but also provoke severe irritation of the walls of the ducts and gallbladder. This can lead first to an aseptic, and then to a bacterial inflammatory process. Often, such inflammation gradually becomes chronic with periodic exacerbations.

Often, the infection enters the biliary system with the bloodstream. This is the reason why patients with diseases of the urinary system, intestines, etc. also suffer from cholecystitis. Treatment in this case involves the use of strong antimicrobial drugs with a wide spectrum of activity.

Powerful antibiotics are represented by Ampiox, Erythromycin, Ampicillin, Lincomycin, Erycycline. Such drugs are prescribed about 4 times a day, in an individually selected dosage. Oletetrin, Metacycline are more often prescribed for chronic cholecystitis.

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Release form

Antibiotics for cholecystitis are used in various dosage forms, which are selected according to several criteria:

• ease of use;
• correspondence to the stage of the disease.

For example, for children, it is preferable to use antibiotics in the form of a suspension or oral solution.

In the acute stage of cholecystitis, it is preferable to prescribe antibiotics in the form of injections - intramuscular or intravenous. At the stage of symptom attenuation, as well as in chronic non-acute cholecystitis, antibiotics can be taken in tablets or capsules.

Names of antibiotics that are often prescribed for cholecystitis

• Azithromycin is an antibiotic that comes in capsule or tablet form. The drug is taken between meals, at an average dose of 1 g per dose.
• Zitrolide is an analogue of Azithromycin, which is produced in the form of capsules and has a prolonged effect - that is, it is enough to take one capsule of the drug per day.
• Sumalek is a macrolide antibiotic that comes in tablet or powder form. The drug is convenient to use because it requires a single dose during the day. The duration of therapy with Sumalek is determined by the doctor.
• Azikar is a capsule antibiotic that copes well with combined inflammatory processes - for example, it is often prescribed for cholecystopancreatitis. The standard dosage of the drug is 1 g once a day, between meals.
• Amoxil is a combination antibiotic with active ingredients such as amoxicillin and clavulanic acid. Amoxil can be used in tablet form or administered as injections and infusions, at the discretion of the doctor.
• Flemoxin Solutab is a special form of amoxicillin in the form of soluble tablets, which allows for rapid and complete absorption of the drug in the gastrointestinal tract. Flemoxin Solutab is prescribed for cholecystitis, both to children (from 1 year) and adult patients.

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Pharmacodynamics

The pharmacological action of antibiotics in cholecystitis can be clearly seen using the example of such a common drug as Amoxicillin (aka Amoxil).

Amoxicillin is a semi-synthetic aminopenicillin with antimicrobial activity in the spectrum most optimal for cholecystitis. The drug does not demonstrate sensitivity to bacteria producing penicillinase.

Amoxicillin acts on a relatively large number of microbes. Thus, the spectrum of activity covers gram (+) aerobic bacteria (bacilli, enterococci, listeria, corynebacteria, nocardia, staphylococci, streptococci), as well as gram (+) anaerobic bacteria (clostridia, peptostreptococci, peptococci), gram (-) aerobic bacteria (brucella, bordetella, gardnerella, helicobacter, klebsiella, legionella, moraxella, proteus, salmonella, shigella, cholera vibrio), gram (-) anaerobic bacteria (bacteroides, fusobacteria, borrelia, chlamydia, pale treponema).

Amoxicillin may not be active against microbes that produce β-lactamase, which is why some microorganisms are insensitive to monotherapy with the drug.

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Pharmacokinetics

When taken orally, Amoxicillin, an antibiotic often prescribed for cholecystitis, is absorbed almost immediately in the digestive tract. The average peak concentration is 35-45 minutes.

The bioavailability of the antibiotic is equal to 90% (when taken orally).

Half-life is 1-1 ½ hours.

Plasma protein binding is low, approximately 20% for amoxicillin and 30% for clavulanic acid.

Metabolism processes occur in the liver. The antibiotic has a good distribution in tissues and liquid media. It is excreted through the urinary system within six hours after oral administration.

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Dosing and administration

Antibiotics for cholecystitis should be used taking into account the following recommendations:

• When choosing an antibiotic, among other things, it is necessary to take into account the age of the patient with cholecystitis. Thus, there is a range of approved drugs for children.
• The main indication for prescribing antibiotics for cholecystitis are signs of an inflammatory process.
• Antibiotics for cholecystitis can be administered as injections or taken orally. As a rule, the choice of drug form depends on the stage of cholecystitis.
• Antibiotics should not be taken for less than seven days or more than 14 days. A 7-10-day therapeutic course is optimal.
• Incorrect antibiotic treatment, as well as ignoring the doctor's recommendations, can slow down the recovery and worsen the course of the disease.

As for the dosage and treatment regimen, it is determined individually, taking into account the severity of the infectious process and the sensitivity of the pathogenic microorganism. For example, Amoxicillin for cholecystitis is most often prescribed at a dosage of 500 mg three times a day, but in severe cases of the disease, the amount of the drug can be increased to 1 g three times a day. In children from five to ten years of age, Amoxicillin is prescribed at 0.25 g three times a day.

Antibiotic treatment regimen for cholecystitis

There are several standard antibiotic treatment regimens for cholecystitis. We recommend that you familiarize yourself with them.

• Aminoglycosides in combination with ureidopenicillins and Metronidazole. Antibiotics are administered by injection: Gentamicin (up to 160 mg) in the morning and evening + Metronidazole 500 mg and Azlocillin 2.0 three times a day.
• Cephalosporin antibiotic with a penicillin group drug: Ceftazidime 1.0 three times a day + Flucloxacillin 250 mg four times a day.
• Cephalosporin antibiotic and Metronidazole: Cefepime 1.0 in the morning and evening, in combination with Metronidazole 500 mg three times a day.
• Ticarcillin with Clavulanic acid 3 g once every 5 hours as an intravenous injection (no more than 6 times a day).
• Penicillin antibiotics in combination with fluoroquinolone drugs: Ampicillin 500 mg 5-6 times a day + Ciprofloxacin 500 mg three times a day.

Treatment regimens may vary, combining other drugs from the proposed groups of antibiotics.

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Use antibiotics for cholecystitis during pregnancy

Antibiotics for cholecystitis during pregnancy are not prescribed, since many of these drugs overcome the placental barrier and can have a negative impact on fetal development. However, there are cases of cholecystitis when it is impossible to avoid taking antibiotics. If this happens, then the antibiotic should be selected only by a doctor, taking into account not only the sensitivity of the bacteria, but also the gestational age.

For example, at the discretion of the doctor, the use of the following antibiotics for cholecystitis in pregnant women is permitted:

• drugs of the penicillin group (Amoxicillin, Ampiox, Oxacillin);
• cephalosporin antibiotics (Cefazolin, Cefatoxime);
• macrolide antibiotics (Azithromycin, Erythromycin).

In no case should you take antibiotics for cholecystitis and pregnancy at random - this can harm the future baby, and also call into question the outcome of the pregnancy itself.

Contraindications

Antibiotics for cholecystitis are not prescribed only in certain cases, namely:

• in case of increased reaction of the body to antibiotics of a specific group;
• with infectious mononucleosis;
• during pregnancy and breastfeeding (except for drugs approved for use in pregnant women);
• if you are prone to allergic reactions;
• in severe decompensated conditions of the body.

In any case, the possibility of prescribing antibiotics for cholecystitis should be assessed by the attending physician, since contraindications are often relative. For example, during pregnancy, certain types of drugs may be prescribed, but their use should be strictly agreed upon with the physician and monitored by him.

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Side effects antibiotics for cholecystitis

All antibiotics without exception, including those prescribed for cholecystitis, can have a number of side effects - especially in the case of prolonged use. The most common side symptoms include:

• development of resistance of pathogenic bacteria to the action of antibiotics;
• development of allergies;
• dysbacteriosis of the intestines, vagina, oral cavity;
• stomatitis;
• fungal infections of the skin and mucous membranes;
• decreased immunity;
• hypovitaminosis;
• dyspepsia (diarrhea, vomiting, abdominal discomfort);
• bronchospasms.

When taking the usual dose of antibiotic prescribed by your doctor, side effects are rare or minor.

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Overdose

If an antibiotic overdose occurs in cholecystitis, it most often manifests itself in the form of a digestive disorder. Thus, nausea with vomiting, diarrhea or constipation, increased gas formation in the intestines, and abdominal pain may be observed.

In addition, fluid and electrolyte imbalances may occur.

Depending on the symptoms present, when taking excessive amounts of antibiotics, symptomatic treatment is carried out, focusing on taking a large volume of fluid to compensate for electrolyte imbalances.

In some cases, initial renal failure may develop, which is explained by damage to the renal parenchyma due to crystallization of the antibiotic.

In severe cases, hemodialysis may be used to quickly remove the medication from the bloodstream.

Paradoxically, in rare cases, cholecystitis may develop after antibiotics due to overdose or excessively long-term use of drugs. Its development is associated with increased load on the liver and hepatobiliary system, and is functional in nature.

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Interactions with other drugs

We suggest that you consider the drug interactions of antibiotics in cholecystitis using the example of the drug Amoxicillin, a semi-synthetic aminopenicillin, which we already know.

The antibiotic may reduce the effect of oral contraceptives.

Combination of Amoxicillin with aminoglycoside antibiotics and cephalosporins may result in a synergistic effect. Combination with macrolide, tetracycline antibiotics, lincosamides and sulfonamide drugs may result in an antagonistic effect.

Amoxicillin improves the effectiveness of indirect anticoagulant drugs, impairs the production of vitamin K and reduces the prothrombin index.

Serum Amoxicillin levels may be increased by diuretics, nonsteroidal anti-inflammatory drugs, Probenecid and Allopurinol.

The absorption of antibiotics in the digestive system may be hampered by the action of antacids, laxatives, glucosamine and aminoglycosides.

The absorption of the antibiotic is improved in the presence of vitamin C.

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Storage conditions

Antibiotics for cholecystitis can be stored in most cases in rooms with room temperature. Some injection drugs should be stored in cool places - for example, in the refrigerator.

Any medications should be kept out of the reach of children.

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Shelf life

The shelf life of a particular antibiotic is indicated on the packaging of a specific drug. Be sure to pay attention to the date of manufacture of the medication!

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The best antibiotic for cholecystitis

Despite all the disadvantages of antibiotic therapy, it is almost impossible to cure cholecystitis without them. For cholecystitis, antibiotics are prescribed in relatively high doses for 7-14 days.

Antibiotics for cholecystitis can be conditionally divided into subgroups according to their principle of action.

First of all, antibiotics are prescribed that destroy the wall of the microbial cell: these are penicillin drugs, as well as cephalosporin drugs (Cefazolin, Cephalexin).

Antibiotics that disrupt protein metabolism in bacterial cells also work well. Levomycetin can be classified as such. Other antibiotics similar to this drug are: Tetracycline, Erythromycin, Gentamicin.

Each antibiotic has its own fixed spectrum of activity, so the doctor can select a drug based on the details of the bacteriological conclusion. For example, if the diagnostic method determined that cholecystitis was provoked by streptococcus, enterococcus or E. coli, then it would be appropriate to prescribe Tetracycline, Lincomycin, Apmicillin, Cefazolin, Gentamicin, Erythromycin.

Inflammation of the gallbladder is a complex disease, so it is not enough to take only antibiotics for cholecystitis. In addition to antibiotic therapy, treatment with other medications is also required - for example, antispasmodics and choleretic drugs.