Treatment of Moderate-Severity Acute Cholangitis (Grade II) with Abnormal WBC, High Fever, or Elevated Bilirubin

This protocol addresses moderate-severity (Grade II) acute cholangitis, defined by the presence of any two of the specific clinical or laboratory criteria listed below. Correct severity grading at presentation is essential to guide the appropriate and timely clinical response.

• Abnormal WBC count (>12,000/mm³ or <4,000/mm³)
• High fever (≥39 °C)
• Age ≥ 75 years
• Hyperbilirubinemia (total bilirubin ≥ 5 mg/dL)
• Hypoalbuminemia (< STD × 0.7)

Management at this severity grade involves antibiotic therapy with general supportive measures. A biliary intervention is also a key component of the approach — the specific agents, timing, and full clinical sequencing are detailed in the complete evidence-based protocol.