Treatment-cholangitis

• Antibiotics (broad spectrum) to cover common bile pathogens (see above) ampicillin + gentamicin (or levofloxacin) ± MNZ (if severe); carbapenems; pip/tazo

• ~80% respond to conservative Rx and abx → biliary drainage on elective basis

• ~20% require urgent biliary decompression via ERCP (papillotomy, stone extraction, and/or stent insertion).

  • If sphincterotomy cannot be performed (larger stones), decompression by biliary stent or nasobiliary catheter can be done; otherwise, percutaneous transhepatic biliary drainage or surgery.