Short-course Antibiotics vs Standard Course Antibiotics in Patients With Cholangitis

Exclusion Criteria

• •Other aetiologies of acute cholangitis (e.g. primary sclerosing cholangitis, (sub)hilar and/or intrahepatic strictures or hilar stents)
• •A recurrent cholangitis (within 3 months)
• •Patients with surgically altered anatomy (leading to biliary-enteric anastomosis)
• •Concomitant pancreatitis, according to International Association of Pancreatology/American Pancreatic Association guidelines.\[18\] Acute pancreatitis is diagnosed in case of fulfilment of 2 out of 3 of the following criteria:
• •* Upper abdominal pain
• •* Serum amylase or lipase \>3x ULN
• •* Signs of acute pancreatitis on imaging
• •Concomitant cholecystitis, according to TG18 criteria.\[19\] Acute cholecystitis is suspected in case one item in A is met and one item in B and C.
• •A. Local signs of inflammation
• •A1: Murphy's sign
• •A2: Right upper quadrant mass/pain/tenderness B. Systemic signs of inflammation
• •B1: Fever
• •B2: Elevated C-reactive protein
• •B3: Elevated WBC count C. Imaging findings characteristic of acute cholecystitis
• •* Concomitant liver abscess
• •* Another additional infectious diagnosis
• •* Admission on an Intensive Care Unit (ICU) at time of randomisation
• •* Use of maintenance antimicrobial therapy
• •* Use of immunosuppressants
• •* Neutropenia