Published online May 21, 2023. doi: 10.3748/wjg.v29.i19.3027
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
The mortality rates of acute cholangitis (AC) have significantly decreased in the last decades. The development of new diagnostic and therapeutic tools has contributed to this result.
The Tokyo Guidelines of 2018 suggest an antibiotic treatment of four to seven days in AC cases without gram-positive cocci. This interval between the recommended treatment days is relatively wide, and the recommendation provided is not based on a high level of evidence (level C).
The aim of this study is to investigate if shorter-course antibiotic treatments could be similarly effective to long-course treatments in adults with AC.
We conducted a systematic review and meta-analysis of the existing literature based on the recommendations of the Preferred Reporting Items for Systematic Review and Meta-Analyses. Two reviewers (Kasparian K and Christou CD) conducted the literature research, study selection, and data collection. The inclusion and exclusion criteria were predefined. The data synthesis, statistical analysis, and Forest plot creation were conducted through the program R Studio version 1.4.1103.
Fifteen studies were included in the systematic review and eight in the final meta-analysis. Most of the patients were classified as Grade I (41,1%) or Grade II (54,1%), while only 4,6% of the participants suffered from Grade III AC. No significant differences were observed between patients receiving a 2-3 d antibiotic therapy and those who were treated with longer antibiotic schemata concerning the mortality (odds ratio = 0.78, 95% confidence interval: 0.23-2.67, I2 = 9%). In all calculations conducted, no differences could be detected among patients receiving shorter and longer antibiotic treatments concerning the rates of recurrent AC and the length of hospitalization.
Short- and long-course antibiotic treatments may be similarly effective concerning the mortality and recurrence rates of AC.
This study could constitute the occasion for the conduction of more primary and secondary studies for new robust recommendations with a high level of evidence to be established.