Primary sclerosing cholangitis
ICD-10 K83.0 · ICD-11 DB96.2

Treatment of Primary Sclerosing Cholangitis with Acute Bacterial Cholangitis (Suppurative Cholangitis)

Patients with primary sclerosing cholangitis who develop acute bacterial cholangitis — including suppurative cholangitis identified on ERCP — represent a distinct and clinically urgent management scenario requiring careful assessment of diagnostic criteria and targeted treatment.

Clinical scenario

Acute bacterial cholangitis is diagnosed when the patient meets suppurative cholangitis on ERCP, or when at least one major criterion and at least two minor criteria are satisfied:

  • Major criteria: body temperature >38°C, leukocyte count >12/nl, or C-reactive protein >75 mg/L
  • Minor criteria: positive bile culture, increase in ALP or total bilirubin above 2× ULN, no other focus of infection
Treatment approach (partial)

In this setting, the treatment approach includes targeted antibiotic coverage against gram-positive organisms — specifically directed at Enterococci. A particular class of antibiotic agents is indicated in this situation, with the specific choice and regimen determined by the full protocol.

The complete evidence-based regimen, antibiotic selection, and clinical decision pathway are available via the structured protocol.

Instant Access to Structured Evidence-Based Regimens
References
DOI: 10.1016/j.jhep.2022.05.011

According to this definition the diagnosis of acute bacterial cholangitis requires either a single criterion (suppurative cholangitis on ERCP), or at least 1 major criterion (body temperature >38°C, leukocyte count >12/nl or C-reactive protein >75 mg/L), and at least 2 minor criteria (positive bile culture, increase in ALP or total bilirubin above 2x ULN, no other focus of infection).

Pending biliary decompression, in patients with sepsis and those who do not quickly respond to antibiotic treatment, the addition of antibiotic coverage against gram-positive organisms, targeted against Enterococci, such as glycopeptide antibiotics (e.g. vancomycin) or oxazolide antibiotics (e.g. linezolid) may be an option.

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