Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 21, 2023; 29(19): 3027-3039
Published online May 21, 2023. doi: 10.3748/wjg.v29.i19.3027
Short vs long-course antibiotic therapy in adults with acute cholangitis: A systematic review, meta-analysis, and evidence quality assessment
Karampet Kasparian, Chrysanthos D Christou, Konstantinos Petidis, Michail Doumas, Olga Giouleme
Karampet Kasparian, Clinic of Oncology, Gastroenterology and Hematology, Alfried Krupp Hospital, Essen 45131, Germany
Karampet Kasparian, Konstantinos Petidis, Michail Doumas, Olga Giouleme, Second Propedeutic Department of Internal Medicine, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
Chrysanthos D Christou, Department of Transplantation Surgery, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
Author contributions: Kasparian K, Christou CD, Petidis K, Doumas M, and Giouleme O designed the research study; Kasparian K and Christou CD performed the research; Kasparian K analyzed the data and wrote the manuscript; and all authors have read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Karampet Kasparian, MD, MSc, Doctor, Clinic of Oncology, Gastroenterology and Hematology, Alfried Krupp Hospital, Alfried-Krupp-Strasse 21, Essen 45131, Germany.
Received: March 4, 2023
Peer-review started: March 4, 2023
First decision: April 10, 2023
Revised: April 11, 2023
Accepted: April 23, 2023
Article in press: April 23, 2023
Published online: May 21, 2023

Acute cholangitis (AC) constitutes an infection with increased mortality rates in the past. Due to new diagnostic tools and therapeutic methods, the mortality of AC has been significantly reduced nowadays. The initial antibiotic treatment of AC has been oriented to the most common pathogens connected to this infection. However, the optimal duration of the antibiotic treatment of AC is still debatable.


To investigate if shorter-course antibiotic treatments could be similarly effective to long-course treatments in adults with AC.


This study constitutes a systematic review and meta-analysis of the existing literature concerning the duration of antibiotic therapy of AC and an assessment of the quality of the evidence. The study was conducted in accordance with the recommendations of the Preferred Reporting Items for Systematic Review and Meta-Analyses. Fifteen studies were included in the systematic review, and eight were eligible for meta-analysis. Due to heterogeneous duration cutoffs, three study-analysis groups were formed, with a cutoff of 2-3, 6-7, and 14 d.


A total of 2763 patients were included in the systematic review, and 1313 were accounted for the meta-analysis. The mean age was 73.66 ± 14.67 years, and the male and female ratio was 1:08. No significant differences were observed in the mortality rates of antibiotic treatment of 2-3 d, compared to longer treatments (odds ratio = 0.78, 95% confidence interval: 0.23-2.67, I2 = 9%) and the recurrence rates and hospitalization length were also not different in all study groups.


Short- and long-course antibiotic treatments may be similarly effective concerning the mortality and recurrence rates of AC. Safe conclusions cannot be extracted concerning the hospitalization duration.

Keywords: Acute cholangitis, Antibiotic, Short-course, Long-course, Antimicrobial, Treatment duration

Core Tip: The exact duration of antibiotic therapy for acute cholangitis in adult patients remains a controversial subject in the field of gastroenterology. A total antibiotic treatment of 4-7 d is recommended by the Tokyo Guidelines of 2018. However, recent studies present that schemata of shorter-course therapies could promise similar efficacy and safety. In our study, we systematically reviewed the existing literature in order to compare the death and recurrence rates and the length of hospitalization between patients with antibiotic treatments of shorter and longer durations. Our findings showed no significant differences between the study groups in all outcomes.