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
Processing time: 72 Days and 18.4 Hours
Research background

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.

Research motivation

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).

Research objectives

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.

Research methods

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.

Research results

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.

Research conclusions

Short- and long-course antibiotic treatments may be similarly effective concerning the mortality and recurrence rates of AC.

Research perspectives

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.