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How is acute cholecystitis treated?
Last reviewed: 04.07.2025
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Non-drug treatment of acute cholecystitis in children
Fasting is indicated. While preschool (up to 7 years) and school-age children with catarrhal acute cholecystitis can go without food for a certain period of time, an individual approach is required for young patients (up to 3 years). Parenteral nutrition is not excluded.
Drug treatment of acute cholecystitis in children
To stop a pain attack, antispasmodic and analgesic drugs are used, in severe cases - promedol, pantopon. Pain can be eliminated by intravenous administration of 2-5 ml of 0.5% novocaine solution diluted with glucose, or 0.9% sodium chloride solution. Naranephral block is effective. For detoxification purposes, 5% glucose solution, mannitol, hemodez are administered.
Antibacterial treatment of acute cholecystitis in children occupies a special place, despite the fact that it is not always possible to determine the etiologically significant microorganisms. When choosing a drug, the degree of penetration of the antibiotic from the blood into the bile should be taken into account. With normal patency of the bile ducts, antibiotics of the following groups enter the bile well: penicillins (azlocillin, mezlocillin, piperacillin), tetracyclines (doxycycline, tetracycline), macrolides (azithromycin, clarithromycin, roxithromycin, erythromycin), cephalosporins (ceftriaxone). The ratio of concentrations of these drugs in bile and blood is 5:1 or more.
Good penetration into bile is observed when using ampicillin, cephalosporins (cefazolin, cefamandole, cefoperazone), lincosamides (clindamycin, lincomycin), fluoroquinolones (ofloxacin), carbapenems (imipenem, meropenem), chloramphenicol. The content of antibiotics in bile can be 2-5 times higher than the concentration in the blood.
Other antibacterial agents (metronidazole) pass from the blood into the bile moderately, the concentration of the drug in biological environments is almost equal.
Combined use of antimicrobial agents is important. Drugs of choice:
- ceftriaxone + metronidazole;
- cefoperazone + metronidazole.
The following combinations are considered an alternative regimen of antibiotic therapy:
- gentamicin (or tobramycin) + ampicillin + metronidazole:
- ofloxacin + metronidazole.
Antibiotics cannot always stop the destructive process in the gallbladder, this circumstance predetermines the peculiarities of monitoring patients with acute cholecystitis with the participation of a pediatric surgeon.
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Surgical treatment of acute cholecystitis in children
Phlegmonous and gangrenous acute cholecystitis is subject to surgical treatment. Treatment of patients with enzymatic acute cholecystitis is aimed at early decompression of the bile ducts. The latter is performed laparoscopically or by traditional surgical access.