This handout is for acute cholangitis. Your care team identified this based on: charcot triad — fever + ruq pain + jaundice (acg 2024).
Other reasons your team may use this plan: reynolds pentad — charcot + ams + shock (acg 2024); cholestatic lfts (alp/ggt/bilirubin elevated) (acg 2024); cbd dilation / choledocholithiasis on imaging (acg 2024).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| piperacillin_tazobactam | 4.5 g IV q6h (extended infusion 4h preferred in severe sepsis) | IV | q6h | Tokyo Guidelines 2018 — broad-spectrum gram-neg + anaerobic; preferred when ESBL/Pseudomonas risk |
| ceftriaxone | 2 g IV daily | IV | daily | TG18 — community-acquired, mild-moderate; pair with metronidazole if anaerobic concern (gallstone pancreatitis, prior biliary surgery) (ACG 2024) |
| metronidazole | 500 mg IV q8h | IV | q8h | Add to ceftriaxone for anaerobic coverage in selected cases |
| meropenem | 1 g IV q8h | IV | q8h | Reserve for severe sepsis with ESBL risk; healthcare-associated |
| normal_saline_or_LR | 30 mL/kg IV bolus over 3h (Surviving Sepsis 2021) | IV | bolus then maintenance | Sepsis bundle resuscitation |
Plan: Acute cholangitis — TG18 grade-driven antibiotics + biliary drainage (ACG 2024)
Call 911 or go to the nearest emergency room right away if you have:
Interval cholecystectomy after stone-related cholangitis; LFT normalization; recurrence counseling (ACG 2024)
Guideline: Tokyo Guidelines 2018 (TG18) — Acute Cholangitis: diagnostic criteria, severity grading, management flowchart and antimicrobial therapy