Title: Levofloxacin versus Ceftriaxone as therapy of acute cholangitis a prospective comparison
Abstract: Introduction: For the therapy of acute cholangitis complete biliary drainage with ERCP or PTC and antibiotic therapy is needed.The aim of this study was to compare intravenous therapy of acute cholangitis with Ceftriaxone/Metronidazole and Levofloxacin/Metronidazole in a prospective and randomized fashion.Methods: Patients with biliary obstruction and signs of infection (T>38C ° and CRP > 5 mg/dl) received in addition to 1,5 g Metronidazole either 500 mg Levofloxacin/die or 2 g Ceftriaxon/die.Early on during therapeutic ERCP, bile was aspirated via the cannulation catheter and cultured.Minimal inhibitory concentrations of the respective antibiotics were determined for each isolate.The clinical course was followed for at least 5 days with clinical and laboratory data as well as blood cultures (immediately after ERCP and anytime fever > 38°C occurred).Results: see table Discussion: The most common bacteria found in acute cholangitis are E. col[, Klebsiella und Enterococcus.Anaerobic isolates were found in 10% of patients.Levofloxacin und Metronidazole show significant advantages regarding the clinical and laboratory course compared to Ceftriaxone and Metronidazole.