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In a trial involving patients with moderate or severe cholangitis, a short duration (4 days) of antibiotic therapy was found to be non-inferior to the conventional duration (8 days) in terms of clinical cure, cholangitis recurrence, and overall mortality, with the short duration group requiring significantly fewer days of postintervention antibiotics.
The following is a summary of “Conventional vs Short Duration of Antibiotics in Patients With Moderate or Severe Cholangitis: Noninferiority Randomized Trial,” published in the January 2024 issue of Gastroenterology by Srinu, et al.
The management of acute cholangitis centers on successful biliary drainage and antibiotic administration. However, the optimal duration of antibiotic therapy following successful biliary drainage has yet to be systematically assessed.
For a single-center, randomized, noninferiority trial, researchers aimed to compare the short duration (SD) of antibiotic therapy with the conventional duration (CD) in patients with moderate or severe cholangitis.
Consecutive patients meeting the inclusion criteria were randomized into either the CD group (8 days) or the SD group (4 days) of antibiotic therapy. The primary outcome assessed was clinical cure, defined as the absence of cholangitis recurrence at day 30 and >50% reduction of bilirubin at day 15. Secondary outcomes included total days of antibiotic therapy and hospitalization within 30 days, antibiotic-related adverse events, and all-cause mortality at day 30.
The study involved 120 patients, with a mean age of 55.85 ± 13.52 years, and 50% were male. Malignant etiology was present in 51.7% of patients, and 76.7% had moderate cholangitis. Clinical cure rates were 79.66% IN the CD group (95% CI, 67.58%–88.12%) and 77.97% in the SD group (95% CI, 65.74%–86.78%), with no significant difference (P = 0.822). Malignant etiology and hypotension at presentation were associated with lower clinical cure on multivariate analysis. The SD group required a significantly lower total duration of postintervention antibiotics (8.58 ± 1.92 and 4.75 ± 2.32 days; P < 0.001). Duration of hospitalization and mortality were comparable between the groups.
In patients with moderate-to-severe cholangitis, a short duration of antibiotics is non-inferior to the conventional duration in terms of clinical cure, cholangitis recurrence, and overall mortality.
Source: journals.lww.com/ajg/fulltext/2024/01000/conventional_vs_short_duration_of_antibiotics_in.25.aspx