Short-course Antibiotics vs Standard Course Antibiotics in Patients With Cholangitis (COBRA)
Cholangitis
About this trial
This is an interventional treatment trial for Cholangitis focused on measuring antibiotics, randomized controlled trial
Eligibility Criteria
Inclusion Criteria: Patients with acute cholangitis due to common bile duct stones, benign or malignant distal biliary obstruction or distal biliary stent dysfunction (only stents in situ for a minimum of 30 days) ERCP with adequate biliary drainage (all common bile duct stones are removed and/or there is adequate flow of clear bile with or without a biliary stent(s)) Absence of fever (temperature <38.5°C) or a decrease of body temperature of at least 1°C has occurred within 24 hours after ERCP Age ≥ 18 years Written informed consent (IC) Exclusion Criteria: Other aetiologies of acute cholangitis (e.g. primary sclerosing cholangitis, (sub)hilar and/or intrahepatic strictures or hilar stents) A recurrent cholangitis (within 3 months) Patients with surgically altered anatomy (leading to biliary-enteric anastomosis) Concomitant pancreatitis, according to International Association of Pancreatology/American Pancreatic Association guidelines.[18] Acute pancreatitis is diagnosed in case of fulfilment of 2 out of 3 of the following criteria: Upper abdominal pain Serum amylase or lipase >3x ULN Signs of acute pancreatitis on imaging Concomitant cholecystitis, according to TG18 criteria.[19] Acute cholecystitis is suspected in case one item in A is met and one item in B and C. A. Local signs of inflammation A1: Murphy's sign A2: Right upper quadrant mass/pain/tenderness B. Systemic signs of inflammation B1: Fever B2: Elevated C-reactive protein B3: Elevated WBC count C. Imaging findings characteristic of acute cholecystitis Concomitant liver abscess Another additional infectious diagnosis Admission on an Intensive Care Unit (ICU) at time of randomisation Use of maintenance antimicrobial therapy Use of immunosuppressants Neutropenia
Sites / Locations
- Jeroen Bosch Ziekenhuis
- Catharina ZiekenhuisRecruiting
- Elisabeth Tweesteden ZiekenhuisRecruiting
- Flevoziekenhuis
- Medisch Centrum Leeuwarden
- Rijnstate Ziekenhuis
- Radboud umcRecruiting
- Canisius Wilhelmina ZiekenhuisRecruiting
- Maastricht UMC+
- Amsterdam UMCRecruiting
- Amstelland Ziekenhuis
- OLVG
- Spaarne Gasthuis
- Dijklander ZiekenhuisRecruiting
- Zaans Medisch Centrum
- Deventer Ziekenhuis
- Medisch Spectrum Twente
- IsalaRecruiting
- Meander MC
- St. Antonius ZiekenhuisRecruiting
- Reinier de Graaf Gasthuis
- Haaglanden Medisch Centrum
- Albert Schweitzer ZiekenhuisRecruiting
- Groene Hart Ziekenhuis
- Leids Universitair Medisch Centrum
- Alrijne Ziekenhuis
- Erasmus MC
- Maasstad ZiekenhuisRecruiting
- Universitair Medisch Centrum GroningenRecruiting
- Martini Ziekenhuis
- Universitair Medisch Centrum Utrecht
Arms of the Study
Arm 1
Arm 2
Experimental
Active Comparator
Very short-course antibiotics
Standard course antibiotics
The antibiotic regimens will be according to the local hospital's antibiotic guideline for cholangitis (e.g. dosage form, dosage, frequency)and/or the national SWAB guideline in the Netherlands. In the experimental group, duration of ABT after adequate drainage will be 1 day. The duration will be 4 days and can be extended to 7 days in case of gram-negative bacteraemia, according to the national SWAB guideline regarding gram-negative sepsis.
The antibiotic regimens will be according to the local hospital's antibiotic guideline for cholangitis, which are based on the previously mentioned national SWAB guideline. This means that the type of ABT, dosage and frequency will be comparable to the experimental group. In the comparator group treatment duration with ABT after ERCP will be according to the international well known and widely used TG18. The duration will be 4 days and can be extended to 7 days in case of gram-negative bacteraemia, according to the national SWAB guideline regarding gram-negative sepsis.