Comparative Efficacy Of Intraductal Antibiotic During ERCP In Acute Cholangitis

Comparative Efficacy Of Intraductal Antibiotic During ERCP In Acute Cholangitis: A Randomized Controlled Trial

Does intraductal administration of antibiotics during endoscopic retrograde cholangiopancreatography (ERCP), in addition to standard systemic antibiotic therapy, improve clinical outcomes in patients with acute cholangitis compared with standard systemic antibiotic therapy alone?

Acute cholangitis is a serious infection of the biliary system caused by biliary obstruction and infected bile, which may rapidly progress to sepsis if not promptly treated. Standard management includes systemic antibiotics and urgent biliary drainage, most commonly by endoscopic retrograde cholangiopancreatography (ERCP). However, biliary obstruction may impair biliary excretion of systemically administered antibiotics, resulting in subtherapeutic antibiotic concentrations within infected bile. Intraductal administration of antibiotics during ERCP may achieve higher local antimicrobial concentrations at the site of infection. This study evaluates the efficacy and safety of intraductal antibiotic administration during ERCP as an adjunct to standard systemic antibiotic therapy in patients with acute cholangitis.

Inclusion Criteria:

• The patients diagnosed with mild and moderate acute cholangitis based on TG 18
• Planned for ERCP within 48 hours
• 18 years old and above

Exclusion Criteria:

• Severe acute cholangitis
• History of antibiotic hypersensitivity
• Receiving cancer chemotherapy, steroids, or immunosuppressive agents
• Concomitant infections
• Recent biliary interventions such as percutaneous transhepatic biliary drainage (PTBD) within last 3 months
• Known or suspected perforated tympanic membrane, myasthenia gravis