Management of acalculous cholecystitis

* The choice of antibiotic depends on whether the infection is community-acquired or healthcare-associated, individual risk factors for infection with resistant bacteria, and risk for adverse outcomes. Refer to UpToDate content on acalculous cholecystitis and antimicrobial approach to intra-abdominal infections.

¶ Failure to improve is defined as persistent fever, signs of sepsis, or evidence of new multiorgan dysfunction.

Δ The duration of antibiotic therapy depends on the adequacy of control of infection and the clinical stability of the patient. Refer to UpToDate content on acalculous cholecystitis and antimicrobial approach to intra-abdominal infections.

◊ In patients with acalculous cholecystitis who are suitable surgical candidates, both laparoscopic cholecystectomy and gallbladder drainage are appropriate treatment options. The choice depends on available local expertise and patient preference. Refer to UpToDate topic for details. Patients who undergo gallbladder drainage require follow-up as depicted in the lower portion of the algorithm.

§ Nonsurgical candidates with an occluded cystic duct are treated with either long-term tube drainage of the gallbladder or medical therapy for any recurrent cholecystitis after the tube is removed.