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No Harm in Stopping Antibiotics After Cholecystectomy for Acute Cholecystitis


 

Clinical question

Does stopping antibiotic treatment after cholecystectomy for mild to moderate acute calculous cholecystitis affect outcomes?

Bottom line

Stopping antibiotic treatment after cholecystectomy for mild to moderate acute cholecystitis does not increase postoperative infection rates compared with a strategy of 5 days of postoperative antibiotics. (LOE = 1b)

Reference

Regimbeau JM, Fuks D, Pautrat K, et al, for the FRENCH Study Group. Effect of postoperative antibiotic administration on postoperative infection following cholecystectomy for acute calculous cholecystitis. JAMA 2014;312(2):145-154.

Study design

Randomized controlled trial (nonblinded)

Funding source

Government

Allocation

Concealed

Setting

Inpatient (any location) with outpatient follow-up

Synopsis

Using concealed allocation, these investigators randomized 414 adult patients who presented to an emergency department with mild or moderate acute calculous cholecystitis requiring cholecystectomy into 2 groups: (1) continue taking antibiotics or (2) stop taking antibiotics during the postoperative period. Those with severe cholecystitis, defined as concomitant dysfunction of other organ systems, were excluded, as were those with acute pancreatitis, cholangitis, biliary peritonitis, or cirrhosis. All study patients received amoxicillin plus clavulanic acid 3 times a day from admission to day of surgery. The treatment group continued the same antibiotic regimen for 5 days after surgery, while the nontreatment group received no further antibiotics. The 2 groups were well balanced, with a mean age of 56 years and mean duration of preoperative antibiotics of 2 days. Approximately half the patients in each group had mild cholecystitis. For the primary outcome of postoperative surgical site or distant site infections at 4 weeks, there was no significant difference detected between the 2 groups in either the intention-to-treat or per-protocol analyses (intention-to-treat: 17% for nontreatment vs 15% for antibiotic group; per-protocol: 13% for both groups). This held true when the outcomes were analyzed according to severity of cholecystitis or duration of preoperative antibiotic use.

Dr. Kulkarni is an assistant professor of hospital medicine at Northwestern University in Chicago.

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