Pediatric Cholecystitis Medication
- Author: Steven M Schwarz, MD, FAAP, FACN, AGAF; Chief Editor: Carmen Cuffari, MD more...
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.
Gallstone Solubilizing Agents
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 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 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.
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 is a broad-spectrum penicillin. It interferes with bacterial cell wall synthesis during active replication, causing bactericidal activity against susceptible organisms.
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 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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