Ascending cholangitis medical therapy

Treatment
When acute ascending cholangitis is suspected, the patient should be hospitalized. Fluid resuscitation and antibiotics are the key interventions, and antibiotic treatment should be targeted against gram-negative organisms and, possibly, anaerobes. Commonly used drugs include ampicillin, gentamicin sulfate (Garamycin) and metronidazole (Flagyl, Metro IV, Protostat), or ciprofloxacin (Cipro) with or without metronidazole.

The mainstay of therapy, however, is the establishment of biliary drainage, which can be accomplished endoscopically or percutaneously. Timing of the procedure depends on severity of the clinical presentation. Endoscopic retrograde cholangiopancreatography (ERCP) is used primarily. However, if the patient's condition is too unstable for ERCP, percutaneous transhepatic drainage can tide the patient over the acute crisis until definitive therapy can be planned. In all other cases, ERCP to determine the cause of the obstruction and provide drainage should be performed as soon as possible.