Cholangitis Medication

Updated: Mar 11, 2020
  • Author: Homayoun Shojamanesh, MD; Chief Editor: Vinay K Kapoor, MBBS, MS, FRCSEd, FICS, FAMS  more...
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Medication Summary

Possible antibiotic treatments include penicillin derivatives (eg, piperacillin) or a second- or third-generation cephalosporin (eg, ceftazidime) for gram-negative coverage, ampicillin for gram-positive coverage, and metronidazole for anaerobic coverage. Some researchers have reported use of fluoroquinolones (eg, ciprofloxacin, levofloxacin) as effective therapy.

The selection and dosing of appropriate antibiotics and other medications listed below or from another source must be performed by the patient's primary physician and gastroenterologist based on history and clinical presentation.



Class Summary

Initial empiric antimicrobial therapy must be comprehensive and should cover both aerobic and anaerobic gram-negative organisms.

Piperacillin (Pipracil)

Inhibits biosynthesis of cell wall mucopeptides and the stage of active multiplication; has antipseudomonal activity.

Ceftazidime (Ceptaz, Fortaz, Tazidime)

Third-generation cephalosporin with broad-spectrum, gram-negative activity; lower efficacy against gram-positive organisms; higher efficacy against resistant organisms. Arrests bacterial growth by binding to one or more penicillin-binding proteins.

Ampicillin (Marcillin, Omnipen, Polycillin, Principen)

Bactericidal activity against susceptible organisms.

Metronidazole (Flagyl)

Imidazole ring-based antibiotic active against various anaerobic bacteria and protozoa.

Ciprofloxacin (Cipro)

Fluoroquinolone with activity against Pseudomonas species, streptococci, MRSA, Staphylococcus epidermidis, and most gram-negative organisms but no activity against anaerobes. Inhibits bacterial DNA synthesis and, consequently, growth.

Levofloxacin (Levaquin)

For pseudomonal infections and infections due to multidrug-resistant gram-negative organisms.

Beta lactam and beta lactamase inhibitor (BL + BLI) combinations (eg, ampicillin + sulbactam, amoxicillin + clauvulanic acid, cefoperazone + sulbactam, piperacillin + tazobactam) may be indicated in the presence of extended-spectrum beta lactamase (ESBL)-producing organisms.



Class Summary

Vitamin K or fresh frozen plasma (FFP) may be used for correction of coagulopathy when needed.

Phytonadione (AquaMEPHYTON, Konakion, Mephyton)

Promotes liver synthesis of clotting factors that in turn inhibit warfarin effects.

Fresh frozen plasma (FFP)

Plasma is the fluid compartment of blood containing the soluble clotting factors. Indications for using FFP include bleeding in patients with congenital coagulation defects and multiple coagulation factor deficiencies (severe liver disease).