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Pediatric Cholecystitis Medication

  • Author: Steven M Schwarz, MD, FAAP, FACN, AGAF; Chief Editor: Carmen Cuffari, MD  more...
 
Updated: Jul 21, 2016
 

Medication Summary

Surgical intervention is the definitive treatment for cholecystitis, especially in the pediatric population. However, bile acids have been used with some success for the dissolution of cholesterol gallstones.

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Gallstone Solubilizing Agents

Class Summary

Gallstone solubilizing agents are used for the medical dissolution of cholesterol gallstones. Ursodiol and chenodiol are orphan drugs that have been approved by the FDA for gallstone dissolution; however, these agents have not been FDA approved yet for children.

Ursodiol (Actigall, Urso)

 

Ursodiol suppresses hepatic synthesis and secretion and intestinal absorption of cholesterol. It does not seem to significantly inhibit synthesis and secretion of endogenous bile acids or affect secretion of phospholipids into bile.

Overall, ursodiol increases the concentration at which cholesterol saturation occurs and allows cholesterol to solubilize in an aqueous medium. It is preferred over chenodiol because of its relative safety.

Chenodiol (Chenix)

 

Chenodiol acts in a similar fashion to ursodiol; however, its metabolite lithocholic acid is hepatotoxic and may cause hepatobiliary damage itself. Chenodiol given at low doses (< 10 mg/kg/d) may actually increase the rate of cholecystectomy. Because of these effects, ursodiol is preferred.

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Antibiotics

Class Summary

Antibiotics with biliary excretion covering enteric pathogens may be administered to control infection. The combination of ampicillin, gentamicin, and clindamycin is a common and well-accepted regimen.

The use of antibiotics remains controversial. Some authors assert that antibiotics are not necessary in simple cases and should be reserved for persistent fever or worsening of the condition.

Ampicillin

 

Ampicillin is a broad-spectrum penicillin. It interferes with bacterial cell wall synthesis during active replication, causing bactericidal activity against susceptible organisms.

Gentamicin

 

Gentamicin is an aminoglycoside antibiotic for gram-negative bacteria, including Pseudomonas species. It is synergistic with beta-lactamase against enterococci. It interferes with bacterial protein synthesis by binding to 30S and 50S ribosomal subunits.

Clindamycin (Cleocin)

 

Clindamycin is a semisynthetic antibiotic produced by 7(S)-chloro-substitution of 7(R)-hydroxyl group of parent compound lincomycin. It inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. It distributes widely in the body, without penetration of the CNS. It is protein bound and excreted by the liver and kidneys. It is effective against gram-positive aerobic and anaerobic bacteria (except enterococci).

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Contributor Information and Disclosures
Author

Steven M Schwarz, MD, FAAP, FACN, AGAF Professor of Pediatrics, Children's Hospital at Downstate, State University of New York Downstate Medical Center

Steven M Schwarz, MD, FAAP, FACN, AGAF is a member of the following medical societies: American Academy of Pediatrics, American College of Nutrition, American Association for Physician Leadership, New York Academy of Medicine, Gastroenterology Research Group, American Gastroenterological Association, American Pediatric Society, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, Society for Pediatric Research

Disclosure: Nothing to disclose.

Coauthor(s)

Andre Hebra, MD Chief, Division of Pediatric Surgery, Professor of Surgery and Pediatrics, Medical University of South Carolina College of Medicine; Surgeon-in-Chief, Medical University of South Carolina Children's Hospital

Andre Hebra, MD is a member of the following medical societies: Alpha Omega Alpha, Florida Medical Association, Society of American Gastrointestinal and Endoscopic Surgeons, Children's Oncology Group, International Pediatric Endosurgery Group, American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, Society of Laparoendoscopic Surgeons, South Carolina Medical Association, Southeastern Surgical Congress, Southern Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Carmen Cuffari, MD Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine

Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, Royal College of Physicians and Surgeons of Canada

Disclosure: Received honoraria from Prometheus Laboratories for speaking and teaching; Received honoraria from Abbott Nutritionals for speaking and teaching.

Additional Contributors

Jeffrey J Du Bois, MD Chief of Children's Surgical Services, Division of Pediatric Surgery, Kaiser Permanente, Women and Children's Center, Roseville Medical Center

Jeffrey J Du Bois, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Pediatric Surgical Association, California Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Melissa Miller, MD Department of Surgery, Medical University of South Carolina College of Medicine

Melissa Miller, MD is a member of the following medical societies: American Medical Association and American Medical Student Association/Foundation

Disclosure: Nothing to disclose.

References
  1. Akiyoshi T, Nakayama F. Bile acid composition in brown pigment stones. Dig Dis Sci. 1990 Jan. 35(1):27-32. [Medline].

  2. Stephen AE, Berger DL. Carcinoma in the porcelain gallbladder: a relationship revisited. Surgery. 2001 Jun. 129(6):699-703. [Medline].

  3. Baldwin M, Eisenman RE, Prelipp AM, Breuer RI. Ascaris lumbricoides resulting in acute cholecystitis and pancreatitis in the Midwest. Am J Gastroenterol. 1993 Dec. 88(12):2119-21. [Medline].

  4. Kong MS, Chen CY. Risk factors leading to ceftriaxone-associated biliary pseudolithiasis in children. Chang Keng I Hsueh. 1996 Mar. 19(1):50-4. [Medline].

  5. Schaad UB, Wedgwood-Krucko J, Tschaeppeler H. Reversible ceftriaxone-associated biliary pseudolithiasis in children. Lancet. 1988 Dec 17. 2(8625):1411-3. [Medline].

  6. Weinstein S, Lipsitz EC, Addonizio L, Stolar CJ. Cholelithiasis in pediatric cardiac transplant patients on cyclosporine. J Pediatr Surg. 1995 Jan. 30(1):61-4. [Medline].

  7. Callahan J, Haller JO, Cacciarelli AA, et al. Cholelithiasis in infants: association with total parenteral nutrition and furosemide. Radiology. 1982 May. 143(2):437-9. [Medline].

  8. Heubi JE, O'Connell NC, Setchell KD. Ileal resection/dysfunction in childhood predisposes to lithogenic bile only after puberty. Gastroenterology. 1992 Aug. 103(2):636-40. [Medline].

  9. Tsakayannis DE, Kozakewich HP, Lillehei CW. Acalculous cholecystitis in children. J Pediatr Surg. 1996 Jan. 31(1):127-30; discussion 130-1. [Medline].

  10. [Guideline] Guralnick S, Serwint J. Cholelithiasis and cholecystitis. Pediatr Rev. 2009 Sep. 30(9):368-9; discussion 369. [Medline].

  11. Friesen CA, Roberts CC. Cholelithiasis. Clinical characteristics in children. Case analysis and literature review. Clin Pediatr (Phila). 1989 Jul. 28(7):294-8. [Medline].

  12. Bennion LJ, Knowler WC, Mott DM, et al. Development of lithogenic bile during puberty in Pima indians. N Engl J Med. 1979 Apr 19. 300(16):873-6. [Medline].

  13. Imhof M, Raunest J, Ohmann C, Roher HD. Acute acalculous cholecystitis complicating trauma: a prospective sonographic study. World J Surg. 1992 Nov-Dec. 16(6):1160-5; discussion 1166. [Medline].

  14. Tse F, Liu L, Barkun AN, Armstrong D, Moayyedi P. EUS: a meta-analysis of test performance in suspected choledocholithiasis. Gastrointest Endosc. 2008 Feb. 67(2):235-44. [Medline].

  15. Giljaca V, Gurusamy KS, Takwoingi Y, et al. Endoscopic ultrasound versus magnetic resonance cholangiopancreatography for common bile duct stones. Cochrane Database Syst Rev. 2015. (2):CD011549:[Medline].

  16. Agrawal CS, Sehgal R, Singh RK, Gupta AK. Antibiotic prophylaxis in elective cholecystectomy: a randomized, double blinded study comparing ciprofloxacin and cefuroxime. Indian J Physiol Pharmacol. 1999 Oct. 43(4):501-4. [Medline].

  17. Suell MN, Horton TM, Dishop MK, Mahoney DH, Olutoye OO, Mueller BU. Outcomes for children with gallbladder abnormalities and sickle cell disease. J Pediatr. 2004 Nov. 145(5):617-21. [Medline].

  18. Ware R, Filston HC, Schultz WH, Kinney TR. Elective cholecystectomy in children with sickle hemoglobinopathies. Successful outcome using a preoperative transfusion regimen. Ann Surg. 1988 Jul. 208(1):17-22. [Medline].

  19. Lugo-Vicente HL. Trends in management of gallbladder disorders in children. Pediatr Surg Int. 1997 Jul. 12(5-6):348-52. [Medline].

  20. Siddiqui S, Newbrough S, Alterman D, Anderson A, Kennedy A Jr. Efficacy of laparoscopic cholecystectomy in the pediatric population. J Pediatr Surg. 2008 Jan. 43(1):109-13; discussion 113. [Medline].

  21. Sigman HH, Laberge JM, Croitoru D, et al. Laparoscopic cholecystectomy: a treatment option for gallbladder disease in children. J Pediatr Surg. 1991 Oct. 26(10):1181-3. [Medline].

  22. St Peter SD, Keckler SJ, Nair A, et al. Laparoscopic cholecystectomy in the pediatric population. J Laparoendosc Adv Surg Tech A. 2008 Feb. 18(1):127-30. [Medline].

  23. Holcomb GW 3rd, Morgan WM 3rd, Neblett WW 3rd, et al. Laparoscopic cholecystectomy in children: lessons learned from the first 100 patients. J Pediatr Surg. 1999 Aug. 34(8):1236-40. [Medline].

  24. Walker TM, Hambleton IR, Serjeant GR. Gallstones in sickle cell disease: observations from The Jamaican Cohort study. J Pediatr. 2000 Jan. 136(1):80-5. [Medline].

 
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Diagram illustrating the technique for laparoscopic cholecystectomy. The gallbladder is retracted with grasping 5-mm laparoscopic instruments, and clips are applied over the cystic duct and artery.
Photograph of a gallbladder filled with numerous small cholesterol stones.
Operative photograph illustrating the position of small (5 mm, 10 mm) trocars in the abdomen of a 12-year-old child undergoing laparoscopic cholecystectomy. By using this technique, the surgeon can avoid large incisions and remove the gallbladder safely.
Photograph illustrating the role of endoscopic retrieval of common bile duct stones. The picture shows a balloon placed via the endoscope into the ampulla for extraction of a cholesterol stone that was occluding the common bile duct.
 
 
 
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